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AF - 44880� T N � a� Q C O > � w � O O � _ Q w 0 � 0 � w � X 1L � � . f, .� � ?. tD ' .. . . , Z O, U a � � Z Z > �a�0 � � ��� O > >: `c��i a � T � ^ V � � � � � � � w � � a m 0 � J Q O � 4 � O Z Q � w � � � Z m � � � a C � � V � U � 3 �' _ $� � m � L ��.+ ,� � � M � � € 3 m C� U � Q � � � o `o � o � ,� � � � c � at � � o x• � c 3 0 � E � �, � T o � • �-a=a. � o '� m rn ts c � , a> m o � � •i t� � a d � � '•� 2 m � -� • � � � � � -� �J 2 �--. � O � w v� H ¢ a Q.. � � m � -g E m ti � �:.. � � ;9 � � � i � '� 2 � (��,� ti F— z � a � � 1�— i U t� �' Z � m ° � � � 2 a v� `� � r 8$88888$88S$ ° ���������000 � tr� t� t� ��► ts tfs y� . v� v� � ris � � � � � � � � � [ �� � � � . � � , . . .: . k � . . .. . � . .. , . , � .� ', � m .� �� Y � � � � .9i �.. y a,. � � �� � m �t Z` '- � � = p� � p 1 � m �y`�%'� �'�.�� ��� � a a`► $ i' �ss * 3 � � � � � � � � _ �� l � d W O � ��'� � i a� r� Q u— A 3 � � o � � � � � � `� �' � � zO�mUtcc�nr�'�� ��c�s, � � � � �� m � a ' o i � I N Z O Q W� J Q O c _ � •Q OC � 4 � � °o, � � N � � � o z � d � ° w � ...� _ � � �r N U � f _� u? a�'c <i 'r � : •• : 0 0 z �, c � � e 0 u u u � u m , � _ 'o ' � L �' s . . O � � C r i 7 � .� � � vi � V Z N rn W � t'3 � � _ U � Z N � ¢ r co H � t�, mQ �~ . ca �d = Q IN � iJ Z a, � }- U W .� � ,�� � 1`�+ � � � � W a 0 � � �^ Li. W � LU m LL � Q F— _ Q....� . Q Z , � � � O U � � s�e�ecr PERMIT City of Fridley L� �-�� � � � � AT THE TOP Of THE TWINS gU I L D I N G P E R M IT ; � R NO. � COMMUNITY DEVELOPMENT DIV. � `�.------ � r � � PROTECTIVE INSPECTtON SEC. ��� � � ( � �"'1 � CITV HALL FRIDLE� 55432 NUMBER REV DATE PAGE O� APPROVED B� �'""'�"� �'' 612-571-3450 910-F15 7/14/95 / / JOB ADDRESS lOS3 F1111IIOi2 Circle NE t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO DESCR. 1 1 Hillwind Townhomes SHEET 2 PiiOPERTY OWNER MAII ADDRESS ZIP PHONE �ain City Townhomes 1252 East Moore Lake Dr 4�200, Fridle , MN 55432 572-8872 3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO Same 8269 4 AFCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO. 6 USE OF BUILDING Residential Townhome 7 CLASS Of WORK CJ_ NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE % 8 DESCRIBE WORK Construct a 32' x 28' Townhouse and a 17'6" x 18' Gara e 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. See stipulations/comments on plan review letter dated July 10, 1995. Paid park fee of $750.00. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE RE�UIRED FOfi ELECTRICAL, PLUMBING, HEATING, VENTI�ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OF CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHOFiIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WOHK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET PARK�NG I HEREBY CERTIfV THAT I HAVE READ ANO EXAMINED TNIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF �AWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO $9S � 11Fj. H7 ��F7. SG WITH WHETHER SPECIFIED HEREIN OA NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE Fire SC PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $621.SO �8SO.00 $95.12 STRUCTION OR THE PERFORMANCE Of CONSTRUCTION PLAN CHECK fEE TOTA� FEE License SC $5.00 $1,619.18 + PF SIGNATUAE OF CON'RACTOA OH AUTHOARED AGENT �DnrEi WHEN PfiOPER� AUD TED THIS IS YOUR PERMIT , T � r �..L S�GNaTUCiEOFOwNEa���OWNEABUaDER� iDATE� BlD �NSo pai NEW ADDI�1 ALTER (1 ll [l CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application �ffective 1/1/95 :s � ConstructionAddress: /��..3 � `l``�L��/�iD,Q�`� �i�-'c�-� ° Legal Description: "�[�o,��... 4. c, �M--�� — Owner Name & Address: Tel. # � Contractor: �T� � �L c.. k To � �- �o �. -e � � � � MN .LICENSE # � � � . Address:':�5.3- �"`a-� ri1o���e G��C,� ����� �u��4-e ao� Tel. # S%�-�3`b7'� �"�-��� 1-�i-t ��'�. Attach to this applicadon, a Certificate of Survey of �ttie . � J lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVTNG AREA: Length ��� 3�— Width �� Height GARA.GE AREA: Length .`� �(vN Width �`� Height DECK AREA: _Length Width Hgt/Ground OTHER: 6�� = L7y /Si" �7c� Sq. Ft. �!`" � '/, � sq. Ft. 3/ � Sq. Ft. Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ � '� � -- -- � /��. � � Type of Construction: °�;��;���,`� � `L � �-/� s Apprax. ComQletion Date: . '7 - 3�-`�1� (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: (U �� t-�( 5� RP�'LICANT:�r��-e�_ °� Tel. # S S�-� ��7 3� r�x.���. c;-4� T-vw,� ho.�.�s � 72-73`�%� CITY USE ONLY • . Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $�/, SD $ 9S�/� $ y� s� � 5�1� � $ �', c.c� $ $ $ - s� $ $ q,��' Fee Schedule on Reverse Side .U01 of Permit Valuation (1/ lOth %) $.50/$1,000 Valuation $850 per SAC Unit $5.00 {State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Detertnined by Engineering � Agreement Necessary [ ] Not Necessary [ } STIPULATIONS: V- � Jan-26-96 02:42P AIR MECHANICAL INC ...._....... .. .. ... . ,� .. . � � � � T U1 � rn Q c O � w Z O g Z W � � N 2 V Ow U0 � Z � �N_ ayC'3 z �Z Z O gZ � U �Q � p O a �. z Z � O Q U � � � a c � 0 Z O V � W Z Z � N Q 0 � � � ��� Q��cn U�ti u�i � � �� c �� � ...i��y � � Q1 � � O Y V « � U Z � w � U m �� � � � o � � � � � 3 � � l ` � V ffi► C Q. C � � ����U� �' �.� � -4�p "� O � � c�u .' .. .r � o •�� ���'� � t 03���.� x��� c � O N � � •� { p � c � � � � � O � � � �� � N '� m N w � � � :� � � � � � no � � ° � Q � '� p� y � m d c a � � H 2 � � 0 LLJ _ U F- ¢ J � � oQ' � � � � � � s � a� � g � � o 69 fA 4 C1 U � � � m � � � a3i � � � � � � G 3 � � _ � u. LL: 'a � C � :7 � a � � � y z at = m V � � 0. � � � � $ � � � � � 4 0 N � � z .0 � m {'\� V � O �z � � w fl. H � U 0 .¢ � � W 'i Q � � � ' 3 I = o p Z W ��aj � N J „��, � d � � � _ O ° � � U � 1- _ N � _ C� :+ m =Z o m o��� Z�m� c vs �rs V� �s g S o an � N tl3 V! � 0 � N m Q I a> c __ 0 � c 0 U � � Q m Z 0 � � o vl � c o � �, o � U OT Q .ffi �� .� � o a�i � �> � � � a^ O � O U C m � �� : Q N � O z � � o � � �i O F: U 612-434-9217 P.02 ¢ O w O z N � �. _ � m E A Z � � `m c m' m • , � r: . �: d D� cff �� � � � � � � c0 N O c� z Q w _ � ^ �� l - � I � � J a � O Z � f'a' 0 Z O d F- • p U � � , � r � � Y � Q N � W � �ti � � � ti � � �� °° d V w a > Q c ' � m � rn � � � � �g O � a' _ w �� 0 � v � �. a � v �, N � �a .= O $ a`. U � T e0 C � a :'c_ 8 � O � � R c w`<°, '� Z � 'y � o '�' U� a o °" � U � w � a SuBJECT c�ty of Fridley `a :� ��� AT THE TOP OF THE TWINS B U I L D I N G P E R M I T r � � , � T NO. � • COMMUNITY DEVELOPMENT DIV. ' j V �'���-, � O � r � � PqOTECTIVE INSPECTION SEC. i � _ , � ����1 � CITY HALI FRIDLEV 55432 NUMBER AEV DATE PAGE OF APPROVEO BY �"""�" ,'' 612-571-3450 9t0-F15 2/23f 96 / / JOB ADDRESS 1053 Fillmore Circle NE 1 LEGA� LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 Hillwind Townhomes SHEET 2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE Kathleen Behnam 1053 Fillmore Circle NE 571-0940 3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OP WOFK ❑ NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE O REMOVE X 8 DESCRIBE WORK Finish basement bathroom 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTFICAL, PLUMBtNG, HEATING, VENTILATING OR AIR CONOITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTflUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWIG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND OFDINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLtED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �$ � 500 $4 . ZS DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PFOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING corv- � 149. JS Fire SC �H. SO STRUCTION OR THE PERFOf;MANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $162.50 s� TUAEOfCON'RACTOAO AUTH0�71ZEDAGENT IDATEi WHEN PROPERIY ALIDAT�D THIS IS VOUR PERMIT ���� � � � SiGNATUAEOFOWNEA�iFOWNEABU�LDEAi IOATE� BLDG iNSP �1�.TE NEW ADDN ALTER Gl [] [] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 3/1/96 ��a / ConstructionAddress: � l'i J`�.� -� �� ( � m o�' e �. : �'G � �2 �v- � � � P � /h r _ SS � �- Legal Description: �h � � �'�h �"''"e- Owner Name & Address: �� `% �'2� v� �� n�� �S� rn2 � Tel. # S`7 �— � 9�/G' Contractor: S,�yn� MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF Il1�IPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. �� ►^s1� �s-P an �� � ,L-�a� �- , �.�► r�s c s��•P Py �.� Corner Lot [) Inside Lot [] Ft. Yd Setback Side Yard Setbacks Type of Construction: -�:��s�� B�E i���} � Estimated Cost: $ �SG� Approx. Completion Date: ���2 / (Cos t on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: ���3 %%,6 APPLICANT: Q;��� a�-r� Tel. #�5 �i -a g�d Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $�� Fee Schedule on Reverse Side $ ,� .001 of Permit Valuation (1/lOth%) $ yiZ $.501$1,000 Valuation $ $900 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ � ,� � T T � � w Q G O s � W 7 � z 0 � U W �- W V% Z Z m w Q N 0 '� � � � � � O� m`c�i ���N U cp ti � � J C� s 0 � � � � � � � W � � a O � J Q t�- � H � Q � G .� � � � i V d 3 �' � � m � � � � m " o �, � � U .o 'c � c ,�. � €� � m a a> �, c � � � -� � m � i � � .fl O � � � ���� .Q .Q � � � � O N Yp •N at.. Rf 3 p � ���� T o � m �1 � � y � O � � rn ts � � ° a� m o � � � N °y' a �m � Q, 3���' ._ � C � � � � � � T � � � /��/� "��J � � � c � � � �, � 2 � � � w a � , � � � �i U � a m � `b E m' w Q � � I�- �J Z a � � �, � z Q a � 0 t� �' z � m � � Z � � a''. i� � \ � 8�8$888$8$oS o �a�nn�r•r.oi..000 �n �t�v�r��v�vs��yys� us Z � 1���� I I� 1 t�? � } � � � � W �� Q G� �' � 'Si Y � � �` Er W �- � � v � m � � � 'a rs � u► � a�i Z � � lSf C � � ( � lL y� � � �y C � •� � � ,y � ic d � a[� 'u� � c� Rt ca ��. 3 m � ¢ " p aD `� � t= _ _ � �` �° d g LL'p�? ��' �a► � `'��,x � � 3 3� c �.. «. °� �f w � 'a o ns e6 � � �q F- nJ. 2 O 0o c� U o�C ���� C'3 C� G�Q � � m 0 � � � m � a � t � � O � � m v � O a d' � Z O � ¢ � Q � U � � � a$ L � � 0 � � �'r � � � � o Ll" Q � � � � � � � 2 0 H O � 0 � u? � � T �i � ti �� EH w � � r .0 ~ U � 7 � � � N � rn T N � � Q c O � � !11 z � g � Z W > � � Z U OW � U 0 � Z v� iQ W _ � a� C7 Z � Z 2 � � � az W U � O Q ao O Q � Z � O Q U � a u 1 � � ., l u� � d �.� � �� � � � 4. `�^ vJ d � � W � 0 4 m O � Q � 7 � Z � 11.1 0 U W tanZ �U Z � � rQ� �. p � � ¢ � °'za� � c � � C7 � � r� � U�ii� � �� s � � � � Y V � 0 � U m� U m � � � � o,� � �, }, � � O � � U � V A = � � � � m y � V ` � 0 o m •-t' o � >' � �?' .� � U � � L � �Q N � t� Q � � U C Q Y � � � � 3 O m � y � !0 ' � � � C �� � o � � � � 'a r� N C � m C a� � d o � nS +' :� � � O � � = � N v = Qd �, . � � � �' S � � � � � .� O Z H � � W a Y � � � a � , \� � 0 � � U � O �r W W � � Z � � � � � o m w Q 0 H � � a� � o 0 � o 0 � r (fl E!3 � �.. � � ftf 3 � m Y +� � ar 3 y� m � � � � 3 a�i� � t(f � +-' � c — � � Z t � > � io v� � a� _' c v � � g. dc�¢�a N j N c� � ►� a c� � �s � 0 0 0 O O N Efl Ef� Ef3 o� � c � � N c� c� � � � ta � N � a rn c .� 0 � c a U Q * Q z� G m � = o p Z W � c� N J m � d � � d � _ � O O U i � U d F'- _ N :C C � � c y = Z O � o � � � z�-mu.. � � � U m Z � F- � Y J � � j N > c O � :. O � � m � Q ,�s ��� � o m � � � j � -� o O\° 0 Q T Y >O > `o N U C lC � �Q � � N a � o c a� v � � o � o E � O N U � � � W � Z N � a 2 N 4f Z d � � � � C m m � N � � t L � � d � � � �� � W W LL J � � f- � Z a . � O i� Z Q w _ � O = O Z � � � 'a d � � �� � � ctt � � � �� e� :� (lS � � � t � � 0 � � m � > O Q d°' _ O O CV � � W W � Z O � U W a � Z`'' W � w a Z � � � H Z W � U g W � � 0 r � � L c� � A � O y � � � C � O 'a Q U � Ri C a 'c � O � � O � c � c o V � c 0 c � o� � a� o a" c U � a '�� , _ 1..:.:.: _ . ! ... C�� �F _ FRtDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(61?) 571-3450 • FAX (612) 571-1287 Februa�y 23, 1996 Twin City Townhouses Inc 1250 E Moore Lake Dr NE Fridley, MN 55432 Re: Final Inspection at 1053 Fillmore Circle NE, Faridley, MN � Dear Sirs: A final inspection was conducted on February 23, 1996 of the above noted address. We found that the construction of the building unit complies to the best of our knowledge and belief, with all the requirements of the building codes of the City and the State of Minnesota relating thereto, and permission is hereby given for the occupancy of said units. If you have any questions on this matter, please feel free to contact me at 572-3602. Sincerely, .GU ��c B Y ESCH Building Inspector :' � � _ ' �� SUBJECT . � ' City of Fridley � �572-3�T��F'ME Tw,NS gU ILDIN�G PERMIT ' • COMMUAIITY CEV�IOPMLNT OIV. r � � � PROTECTIVE INSPECTION SEC. i . , i_---� �"' �•� CITY MALL FRIDLE� 53132 NUMBEN � 612-571-3450 9�0-Ft5 10B ADDRESS 1053 Fillmore Circle NE t IEGA� �OT N0. 9LOCK 7RACT OR AODITION oesca. 1 1 Hillwind Tow 2 PROPERTY OWNEN MAII AO�R�S$ 3 CON7RACTOH MAIL ADDRESS Top Gun Inc. 5014 Parrish t�.Xe NE Rogers 4 ARCHITECT OR DESIGNER MAIL AODRESS 5 ENGINEER MAIL ApDfiE$S 6 USE OF BUILDING Residential 7 CIASS OF WORK 'l28795 R\ E: fP� . REV OAT@ PAGE OF APPROVEO BY 12/31/98 � � SEE ATTACHEO _ _ SHEET P ZIP PMONE PHONE PHONE LICENSE NO I R�� LICENSE NO. IICENSE NO � NEW O ADDITION O ALTERATIpN � REPAtR O MOVE D REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM STIPUTATIONS Call for building wrap inspection before covering. SEPARATE PERMITS AFE REOUIRED FOR ELECTR�CAL, P�UMBING, MEATING. "` v• Vv•� VENTIIATING OR AIR CONOITIONING THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUGTION 20NING AUTHORIZED IS NOT COMMENCEO VjIITHIN fi0 OAYS. Oii If CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PER100 OF 120 OAYS A7 ' ANV TIME AFTEii WOqK IS COMMENCED. NO DWLG. UNITS I HEREBY CERTIfV TMAT I HAVE REAO ANO EXAMIN�O THIS APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECi. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TVPE OF WOFK WI�L BE COMPLIEO WITH WHETHER SPECIFIED MEREIN OFi NOT. TNE GRANTING OF A PEfiMIT SOO DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CAMCEI TME pEqMITfEE PROVISIONS OF ANV OTHEq STATE OFl LOCAL LAW REGULATING GON- STRUCTION OR THE PERfORMANCE OF CONSTRUCTION ��i _nn SQ. fT STALIS pOUP OCCUPANC�LOAO � CU FT. OfFS1pEET PARKING IGARAGES .50 PIAN CNECK FEE TOTAI EE Licens $5. 0 $27.00 $iGNAfUpE OF CON'�7A(;TOQ Op AUTMOQ�ZED �GENT IOATEi MEN ROPE LIOATEO T IS IS YOUR PEQ / • /" r ��GNaTUAE O� OWNEA��� O�NNEpBU40Ep� �OATEi � � Bl iNS� ' � ���iF � NEW Y [ J ADDN [ ) ALTER [ J CITY OF FRIDLEY SINGLE FA1�IILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1198 (A, -J'� ConstructionAddress: ` /� S �� �-c �� yb,,t P,.-. o i.egal Description: Owner Name & Address: , Tel. # Contractor: '� p � �' !,� � MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Al{ach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IMPROVENIENT W idth W idth Width Height Height Hgt/Ground Tel. /# y� —SS a4 Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: � Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: s'j� APPLICANT%��� �- Tel. #� ��� —��� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ `G(i $ F � $ . � $ $ -�'i �-�' $ $ $ $ $�� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary ( ]