P - 48676�uuaing BUIL�ING
In�pec�ians �E��DE�i1�TI�4L APPLICAT�
763-57�-36� ��
____ CI'�'Y C1F FRIDLEY
str� �+rsa�ss �
?HIS APPLICANT7S:
TENANT
YO[JR �-MAtL ADDRESS
,�. _ _
Dt?1VNER DC()NTRACT'�ti
AG?p[tESS
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Received By:,�
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...,,. , �.�,, �„� rr�a..n��: Renewal By Andersen
SUBMfT A COPY dF STATE L�ENSE #� 1920 C+aunty Road "C" W�st
YDUR STATE LICEIVSE ADDRES5: RQSe�11IEi MN 55113 r STATL ZIP
wt't��pucA�-[Qrr p�oxE Lfcense #BC230983
pRUPERTY TYPE o sixc�.� �aM�t,Yn�� 651-26�4-47Z7
0 TWO FAMILYR�W . —
PC' RMLT TYPE ❑ ADCiITEQN L7 GAN:ACE/SHED ^_---_.. ..�_-'C5 WIIVDOWS _
Cl BASEMEFfT FihilSFf O R�OF -_ O DRAiN T[LE
I, 13 D&GK D SIDINCi O flTHER
DESCRIB� WQRK BEING
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PRf)POSED Si2E_
�ROPO$�D HEF�EiT:
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O 4)ther
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1N EXlST]NG'.Of'ENIMGS pYea L]No
OR FpR NEW pp�N[NGS-�ESCR{BE �[ZE OP
�PENIN(i +CHANt3ES d2
' Petts�it Fee
Rlan Review
Fire Sutcharge
Surchaz'ge
License Surcharge
SAG Chargo
Curb Cut Escmw
Erosaon Csrntrnl
Park F�e
Stwer Main Charge
ARE BASED OI�I V
CI }i0U$� � GARAG€'
O A?TACFiE� C}ARAGE
� D�TACI-IBD GARAGE
�Spl`tit
O Trim
0 Fascia
�OCA'ftONQF WIMDOWS
�Er �1�7 U.H.0 FEE SCHEQULE)
� —1 �MI�Y fU k #t/��
�ASEMENT �E±jvtCll]F .i.l„�('�+gMiT•
1. 4xiatin� Flnor Piaa,
2. Propoeed floor plan
3. L iet of ahuctoral' meathers to F�e u�ed
FOR NEW CdN8'I'1�UGTION 1NCLU1}FNG DECKS, .
1_ Sits Plar✓Suev�y showing � cxisting suuctun
�nd prapQSed parojsxt,
2. Two sersofe�asauaeion pieoe
3. En�rgy Cklcu[stiune
�' ___s r?f 1..�� - 5ee �a.ek Pa�e fc�r F�e Sc�edu%
� � 65°fo of Build'tng Perrnit �ee
� __� .UU 1 tirnes the total job valustion
.4405 x Permit Val�,atiQn Mis�imum 5.50
� �� $5.00 {S#a#e Licensed Residential Contractors)
$ � 1550 per SAC Unit {Plans to MWCC for dete�rntination)
�' ft+6it� fixSZ!=$
$ � �.�.
a450 Cons�ervation Aian Review
� Fee I?etertnined by Ertgineering
� Agreement neaessaTY ( } Nan N
� _ � xn �T`-- .. . _ _ ecessarY { )
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tH13 IS A'J APP'L[CATtC1N Ff.�t A PERMlT-Nt?T YAL[D UNT7L PRqCFSSED .
! heceb�y apply for a buiiding permit and I acknawiedge that the inform$tion above is complete and a,ccurate; t�t the worlc wilt be �
conforrnaisce with the ardinances and cocles of the City of �ridley and with the Mau�esota Construction Codes; thet !` �d �� nc�t .
permit but oniy an applicatian a perrnit acid wor[� is nat to s#art without a pe.rrni� that th� w„ork yviIi Ix in e�cardat�ce with E�e approve,
plan in the case ofall work wh' r+equires revi nd a�Proval of pians.
51GNATURE QF APPLICANT INT NAQNE�1 ]��Ce�4r� 1�4'�1'�"���" DATE� �1_ ��'�rrc
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