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P - 48379Bt�ilding BUILDING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: r' t 763-572-3604 CITY OF FRIDLEY Dat��d: ��``' " ` f�� l 763-502-4977 FAX EFFECTIVE 1-1-2011 � DATE (p � S,� �` YOUR &MAIL ADDRESS -�o � U � '�G d � S e� �^' . C � � �-�- SITE ADDRESS `1 (�O iL � �e�v Vc .Q...� T�2 ✓�rc•.�.� � f-�r. c�. %.-� /1/l �J s5 y 3 z THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY OWNER/ NAME: r.�, o. y. cL ��. �� f� TENANT ,�,DDx�ss: � 13 n (Zi .�.e r v� ��-,+ T�n.�eCITY_ �r. d(.� sTn'rE�zrn .�'S`i 3 2 PHONE: i 6 3 ^ � � � �'l - 2J �{ � CONTRACTOR xnME: .�'( (Ci ��•,, o� Z � S 5 v �- � c�-,/..e S 3 ..c -.� �. SUBMIT A COPY OF STATE LICENSE #_ �"3 / 9 l O 5 LEAD CERT NUMBER 1� "�'�S�I3— � ��O /�" 3 YOUR. STATE LICENSE Z AND CBRTIFICATE OF ADDRFSS: ?_ScCo o ('?� S�'�h �v2 /lJ� C1TY��o..►a .� STATFf++� Z� SS 3oy INSURANCE PHONE Z— 'Z �f� � Co ( �f FAX " Cc 2 — � �/ / PROPERTY TYPE SINGLE FANIILY/NEW CONSTRUCTION S1zE k�a I(c o�1` 2� — b i� ^ ❑ TWO FAMII.Y/NEW CONSTRUCTION STORIES_�_ PERMIT TYPE O ADDITION O GARAGFJSHED O WINDOWS ❑ BASENNIEIVVT FINISH ❑ ROOF ❑ DRAIN TILE `�ECK ❑ SIDING ❑ OTEIER � SWIIVA�IRIG POOL TYPE OF WORK: O NEW HOME CON3TRUCTION ❑ ADDl`fION ❑ MAINTENANCFJREPAIR DELING DESCRIBE WORTC BIING DONE:� ..- o.ti.a. � n F e r� � s'i�-� ��.� ��5 d�- � a�r. d-, d- r e� 18.., e w� D.e c�a , SIZE OF IIKPROVEMENf LENGTH � � WIDTH � FIEIGHT r FP �3 Z �� O HOUSE ONLY BASE�nrr RHaanDEL�NC S��MIT: NUMBER OF SQUARES ❑ HOUSE 8t GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARACiE 2. Proposed floor plsu PROPOSED S1ZE: ❑ DETACHED CrARAGE 3. List of sd�uc�ual membas W be uaod PROPOSED I�IGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, �� Ai>DITIONS_ � PORCHES SL1R1_�!Y!': 1. Sibe P1an/Sim+ey showing the exis� sh�hu�es ❑ Aluminum ❑ Trim and P�P� Pm.l� ❑ Other ❑ Fascia 2. Tw�o sels of � plans WINDOWS 3. Fna�+Calwtatioas IN EXISTING OPENINGS OYes pNo LOCATION OF WINDOWS FOR WtNDOWS—PROVID$U VALUE AND OR FOR NEW OPFNINGS-DESCRIBE SIZE OF MANUFACfURE STICKER ON W1ND()W. OPENING CHANGES 8c TYPE OF WIIdDOW TO BE INSTALLED NUMBER OF WIIdDOWS ALL FEES ARE BASED ON YALUATION, INCLUDING THE COST OF LABOR AND MATERiAIS: Permit Fee Plan Re�+iew Fire Surcharge Swrcharge License Swcharge SAC Charge Gtiub G�t Escraw Erosion Control Park Fee Sewer Main Charge (USING THE 1�9'7�iJ.� �EE SCHEDULE) $' . L Sce B�ck Page for Fee Schedule S 65% of Building Petmit Fee $ .001 times the tatal job valuation $ .0005 x Permit Valuation Minimum 55.00 $ $5.00 (State Licensed Resid�tiai Conlractors) S $2230 p� SAC Unit (Plaos to MWCC for debermination) $ ft+6ft= ftx$25=5 S 5450 Conservation Plmi Revievv $ Fee De�termined bY �8��8 $ ASreem�t necessarp i) Nan NecessaiY i) $ I I'1 � Make ch�ks m�rable M: Citv of I�Yidle_y Attxc THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclmowledgc that the information above is compl�e and �ccurate; ti�t the work will be in conformance with the ordinances and codes of the City of Fridlep �d with ffie Minnesota Conshucti� Codes; �t I understaad d�is is not a permit but only an applic ' ' and work is not to stait without a permit on site; that the wodc will be in accordanoe with the approved plan in the of all work 'ch regt� 'ew and approval of plans. L-�^l // SIGNATURE OF APPLIC nn.i, Z� RINT NAME -�'%'p w_ v►`�` DATE � s I� 1 �� aa•a w. �.�.r '�t� � •� ��Q��i�Q ■ �noQ�9f�� U � � E� � � a� .r., �; a � > �� .� �.., �� 0 M � ti 0 � � � � 0 � � � � �° � a� � � a a� � � � bA ,� � cd � Q °,�.:. �a � osu �a � �NOLLYJO'I �� ;�Q �7�[ � �nrx t�sroga zN d�o � � °-'"' Z U � Y Z (/) �~�i �W ��N N��O ��H � �� Q c.>�aw ~ I 1 1 1 1 I 1 �NM� � �� _ 1� � `�'«_' � � i� � � � �� 0 �W z < ��i 0. � 4aQ va� '� � r � �t�1p�}t�� s ��o�� 0 : ��1 �!8 OCiI. �NOU.Y�O'I ��Q �i�[ ��IYN 7a3tOHd . . . �i �tl c tii � � ° °� v y m Q ~ 3 I ts[ [t—r—t t �, � @ ± a� �i � a8 .� � �j � � I o7oQ ! � �° ° \ � a � N IF� n y � .A-.9 � a . a�a o� � +�o� • C�MQ�I�AQ ■ �oa�� 0 9 l � • � � � � �� ----1 s. ----� � a r -r � a m � � � � � I I 1 1 q I I i I + p� I 1 I I� .L.11� —.0-.t—1 • � ,a •�u �a �+� osu •NOLLY�OI � .�pt :� �d �� M r .O^.9 .u-.f � A-.i � N M . p M I� ' �_ � '^� � � � � � � I � ' ( J _ � M N ��II�I\ ' � ✓ 4 � �� q o �- �- J � ^ � � H � N1 d 1 � } �� N � �� o� � M x � � �� '� I I �� 09 Q � s � � M � 7R- Y , � � � � �� r �% ,�% /�_ � ��/° � � � � � � J �� n^ N �� J �� A, � V/ � a � � � � e J — 0 � ¢ i W � J W Z] ��L.. � •� �a v!� osu �xouw�oz a�a �i ��tvet 7�atoud �� wwpa �wa �a m�� ---�.o-.s—�-) � ° "\ �� W �N n � � � � Z � Q W � s. W • W a H � a .