P - 48045CITY OF FRIDLEY MOVING [] DEMO [] PERMIT APPLICATION
6431 University Ave NE �
Fridley MN 55432 ��l%_., �'j �� ��
(763} 572-3604 FAX (763) 57 - 87 ���1 �
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Job Address : l��a T�wt L l�r�^�CL � '��. G�(,� . �ti�
Legal Description: e,-vt�v:,� � � �' ,� :.v��nm;.� �a � �
Owner & Address:__���;,y� ����e�� 7�ta� i`e�P� fe,�r�.c� ,�r: ����el.
Contractor: d�/�;21�, Tel.
Address:
State License #
DESCRII'TION OF BUII.DING
HOUSE: Length Width Height Sq. Ft.
GARAGE:Length Width Height Sq. Ft.
OTHER: Length 3 8` Width � h � Heiqht � p'� Sq. Ft .
Estimated Cost $ Z,S-c`?Z�, �� Approx. Completion Date
S°'S'�1 � z
# �/z°3f��iZ�id
#
Cu. Ft.
Cu. Ft.
Cu. Ft.
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CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATION3. CALL ALL
UTILITIES FOR DISCONNECTS BEFORE WRECKING MOVING STRUCTURE.
Moving Route:
APPROVAL(S) REQUIRED PRIOR TO ISSUANCE:
MPCA: NOTIFICATION OF INTENT TO PERFORM A DEMOLITION () YES ( j NO
DISCONNECT PERMITS MUST BE ISSUED PRZOR TO DEdlOLITION.
� Water 11 Paid: Yes[ ] or Collect jSi ture r
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B1 l ficial Con itions �� ��
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Engineering Conditions
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Fire Marshal Conditions
The undersignsd hereby makes application for a permit to wreck/�ve the building described above, agre�ing to do all work in strict
accordance with the City Ordinances a�d rulings of the Building Division, and the State Code which requires any water well on the
property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application
are true and correct.
�—Date
Moving (/
Principle building into Fridley . . . . $300.00
Accessory building into Fridley ... $ 42.00
Through or within the City ......$ 20.00
Move a building out of City ......$ 20.OQ
PERMIT FEE:__1`�
Effective O1/O1/2011
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,// Wrec '
For each 1,000 cubic feet or fraction.. ....$1.25
For structures which would be impractical to
cube, the fee shall be based on the total cost
of wrecking at the rate of $6.00 for each $500.00
or fraction.
MINIMUM $20.00 Off'ice Use Only: SAC-D form completed
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