P - 44194From: City of Pridley To: 9528812936 P�ge: 1/2 Qa�:11172/�00914:5Q;28 AM
��L��i�ar Pcnmit No,:
ItESIDEl�TI�iL APPLXCATTON �e��lv�a s
�63�5"�2-3604
7G3-SU�-4977 �'A?�
CIT�Y O�' .�+ RIDL�+ 'Y
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DATB �����_ YOUR 8•MAII. ADDR&9S /�i"� �i �,,��E � a ,. e� �.� � �� d,�G - � M
srraa annxHSS .$�.,? � �.��"`
�IIS APPLICAN'T IS; G OWN�R �ONTltACTO�
I'�iOPLRTY OW1V�12/ NAME: �Dt1'�'t .� r/ r,.,��/
�,'LNANT ADDRESS: �'0.�� lS�a.7!�t ��� QTY fis %� STATF/�ZiP, Y.��
PI�ONE:, 7�G � " r ���L,�-� �
SUH�ulI'� A EAPY QF
YoUR 9TATB LIC�NsH
AND Ci3RTIFICA7'� OF
INSURANCE
9TAT�3 LICENS&
LE FANIILY/N6W CON9TRUCTIi
TAMi[.YlIdSW CAN�TRUCTION
� BASEMSNT F1HIBH O ROOp
p DSCK 0 SID1Na
TYPL� OF WORxC: O NBW HO�iS CONST1tUCTtO�T 0 ADDI7��N
0 MA1NT&t3ANCE/R�l'Aut q RBMOD8L1riG
D$S�SWORKBffi��D02dB: ,� +� � �+�
S]Z� OF Il�IPROV�M6NT �� LBNQTH -- WIDTH
p� bBWG � Hovss oHI.Y
NUMSSR OF SQUARBS ,__, I� HOUS� da GARAOS
RA ES O ATTAC�IeD GARAGg
P08E� S1ZB: C7 DSTACHBb GA,RACrB
PRdPOSEA HBtGH�T',�
G
CJ Viny .
[a Alumumm
t� OI��r _ _
IN EXI� G QPEMNGS �ea I�No
OIt FOR iVBW QF�J(i9•D C�itBB s�B OF
OPENINO CSANtiBS db
A,LL
Parmit Fes
Plan Revisw
Fire 5tuchargs
Surcherga
I�icenee �urcharge
SAC Cherge
Curb Cut 8sa�ow
Brosion Contml
Park k'se
Sewer Maiu G'ha��e
OSo�it
❑ 1t�im
O Nagcia
LOGATIO'LZ 4F WII+@OWS
fiXP DATS
0 DiIAtN T1�.8
❑ �'1'i�t
fSTALLAD , M3MB8R OF WINDOW& i _
BASiED ON'VALVATxON, INCLUDIIVG TI� GOST O�'
. (Ul9ING'rEE 1997 U.B.G F�E &CH�CCDULE}
���� S
R '
1. fixistiugFoorPlen
2, Propogecllloorplan
3. Li�t of structuraf maabam ta be nied
FOR NEV4► COMSTRUGTiON INQ.UDWC4D�C�CB,
ADDI1i0 . � Pc1RLHE8 �MiT:
1. �Ite Pl�N3�rvay �owia� Ule exisf3ng �ucttH�z�
xnd prap�ed prqjacc.
2. 71vo aota aiconsWottat p1w�a
3. Bnar�y Calculatiops
�`Q G . o ANCY TYPE
$ 9se Saak Page Far Fes 3ohedule
$ 659�b of $uilcl�og P�r:ttit Fee
$ .001 timsg th�o to#al job valuation
$ .0005 x Permit Valuation Mmimtutn $.50
$ �t�lj �5,00 (Ststa T.icer�ed Re�id��xtial Cona•actorn)
$ $200Q p� 3AC Unit (�'lsns to MWCC £or det�rminatian,)
$ ft+6tt� i'tx�21 =$�
$ �450 Consarvation Plaz►R�tricw
$ Fea Dateimined by Rngineerit�
S Agrne�mentnecea�a�y ( ) I3ar►Nsoea�ery ( )
THI9 I9 AN APPLICATlON FOR A P�AMIT NOT VALID UNTIL PItOCBSSBD
I hsraby apply for a buildir� pcaccmit and X aclmawledge that the infrn�snat,ion above is c�plete and eoa�ate, tb�at ths work wi�l bs in
confor�m�c� with ths ord.inancsr snd oodea� of the City of Fridisy and with the Minnerata Canstruction Codes; that I uada�tan�d tlus i� rxot a
psrmit but only an appl�cation far a permit and work ia �not to start without a pas:ait on aiss; that tha work wiil btl in aoaax+danca with tha
approv�d plan Sn the o�aae of all work whioh requires view and ap�roval af plans.
SIONATURT OF APPLxCANf ,��� .�rr� PRINTNAMB /i ��•/riS� �� G DA1'B �� .��.,
� , , , .. , ,...,
Wb Oti�9Z� 4 4 600ZJZL/L 6�a3�O £/Z :a6ed unnou�un :wa�
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