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Building
Insp�ctions
763-572-3bU4
��3-sa�-4977 FAX
BUILDIN�
��SI.UENTIAL AP�'X.,XCATI4N
CI'�'X O�' �'�IDLEY
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SUBMIT A COPY OI�
VUUR STAT� [,ICENSf
ANTJ CLR'1'II�ICA'I'G OP
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PRO['�RTY'1'YpE:
1'CRMIT TYPE
STATG LICENSI3
YOUR G-MAIL ADD[�CSS
PI�I�Nf; l�11 �� La�� ' G I C,� d
C�' tiINGt,� PAMILY/NCW CONSTRUCTION
O TWO TAMILY/NGW CONS'I'RtIC'1'10N
I� noniTiON O GnitnG
Q I3ASEMCNT FINISI I � R4UI�
❑ DECK ❑ SIDINU
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TYPE OF WORK: ��iCW FIOML'• CpN�TRUC'rlpN ❑ ADDiTION
�MA[N'ffNANCF./RF.PAiR ❑ RCMODL'LING
DG5CRI�G WORK DGINC, DONL', � Yl r' ���,Q, I
SI%L UI� iME�ROVr-.Mr-,NT LL'NG'I'!�i wInT1�i
,F�,Q,Q, �'i�v,i�', 0 I�IOIJSI.ONI.Y
NUMiif:R OP SQUARGS Q I-IQUSG K GARAGG
I . 'ti
PROPOSGD 51'/.L•
PROPOSGD IiGIG1�IT:
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0 Vinyl
t7 Aluminum
O athcr
o n�r•r'ACf-Ir17 GARAGIi
l7 ni� fACI�1LD Gt1RAGG
CCRT NUM
1� _ C1'1'Y
� DRAIN TII.0
❑ OTI fER
Permit Na.:
Recei I� lVT� �
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l3ASE;MI�N"LRGMQDGf.fNG SUf�MI'f:
I . L'xiating I�lonr E'1un
2. Propo�cJ Ituar plun
3. Litil of xtru�lurul memt�ctv to be uscd
I+(}i; NICW CUNS'fE2U(TION fNCLUpING DfiCKS,
Cl5oflit AbQI'I'IUNS.lt PORCI-Ii5 SU[iMiT:
Q.�,r��� I, Sitc PlanlSurvey �howiug llio cxi,ting structures
Q l�uyciu m5d propaxcJ project.
2. 7'wo xclr oi'construC[ion plony
wirun�wc 3. Lncrgy Cu(culations
IN C�IS'I'INC OI�t,N�N{�� l�cs ❑No LOCA'I'ION Of' WINDdWS POR WINnOWS — PROVIDG U•�ALUC AND
ORI'ORNLWQI�L•;N1NCiS.Df;SCRifiFSilGOT' ��J� __ MANUf�ACi'UIiGS'fICKL'•RONWINDOW.
OI�GNINfi CI�lANGL-S b` "?
TYPG OF WINDOW TO E�L• INS'I'ALLI3i] QL� NUM[3C2 OF WINDOWS �
ALL r'ECS AftC �3ASED ON VAl,UATIQN, INCI,UUING TI•IE C4ST D�' LACiOR ANU MAT�RlALS:
UStNG TH� 1997 11,�3.0 f E� SCN�DULE)
'I'0'iAL d08 VALUATION $ I�O.O OCCUPANCY TYPE
Ptrmit Fcc � ,2 See Back Pagc for Fcc Schcdulc
P1An Revicw $ 65%of Suildie�; Pcrmit Fcc
F'ire 5�rchargc $ .001 timcs thc tptal job valu�kion
Sureh�rge $ .Q005 x Permit V�lu�tion Minimum $5.�0
Liaense Surch�rFo $ � �S.dd (St1te Li�cnscd Rosidonti�l Gontra�tors}
SAC Chnrge $ $?230 per SAC Unit (Plnns to MWCC for dcter�t�ination)
Curb Cut �scrow � t� t G fi = tt x$?5� $
Crosion Cantrol $ �$4S4 Conscrv��ttion Pl.tn Review
Park Fcc $ Fee Determined by Cngineering
Scwer Main Charge $ ��� ' Agrcement necessnry () Non Necessnry (}
Tot��l Duc � � I.�-1 C M�kc chccks navnblc to: Citv of F'ridlov Attnch Stiaalntionk
TI�I15 IS AN APPLICATION 1�OR A I'3:RM1'I'-NUT VAL1d UNTIL PROCf:SSED
[ hereby npply fQr ,► buidding porinit u��d l ucknowleclge hat chc information above is complete and �ccurate; th�t the wark will be in
eoni'orm�nce with the ordinances And codes of c City idley and with the Minncsotn Canstruction Codes; that I understand this is not �
permit but only fln application for a pennit And rk s t to start witltiout a�ermit an site; tlint the work will be in nccordnnce with the
approvcd plan in tlie ense of flll rk which rcqui s vi and approvnl of plflns. i
S1GNA"fURL QF APPLICANT _ _ _ _ INT AMG_��f�_��L7��DATG �' �1 � � �'
AFPROVAL INSIyLC'I'C]I251C7NA'ft1 G
PLEASE NOTE: SEPARA'!'� P�R S QUIRED F R PL[JMBING. ELECTRtCAL AN.17 MECNANICAL W�RK
�ii a n1�+,_�nr. �C0/1 �. c�i a.mcaiiinu i i�ni i c_i n_�i n�
Wd b£ Z9�6 ZLOZ/6£/6 :al�a Z/6 :a6ed aan5au.�oH :wa�