P - 39389Building
I nsp�ctions
753-57Z-3604
763-502-4977 FAX
na.� ��.�1�
517E ADDItESS �
THIS 4PPLICANT I5�
TENAN�'
SUT3MjT A CQPY OF
YO[J12 5•'FATE LiCENSE
AND CERTIFICATE OF
iNSURF�NC�
PROPERTY TYPE
PERMFI' TYFE
OF' R��DRK:
From: unknown Page: 2/2 Date: 9/6/2011 9:20:22 AM
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RES�I��'�`IAL A.�'�'L�CATION
�C�'� �1F F��E�'
XOUR F..-MAII. A�1�l2ESS
❑ ()WNER
I�'
S"�['A'1'$ i.7CBhISB ;F
C�T
PHON� (k?.?"L�►^ U'"'! ��' FA7t !�- J�
�'S�INGLE FAMILY/NEW CONSIRUCTION SIZE
0 �ud Fnh4Mx4�mrEw CONS'�tUCTION sTORi�s
QAI7bI?IOiv � ❑ G1�RAA�E/SHED O W,fN"POWS
o aws�rrz �►tvfsx a�tt`v�,k a nw�v -ra s
❑ T�F_CK � SIDiNG O OIHEl7
a swmn�N� ieaaT,
a �w �r_+n� c�a�sriz�Ycrtov � aPDTIION
�r�NaxcEnz�a�rx o �on�.txG
Pe�it
Rec�xved sY:
n�� ��"� � � � L1-� , 11
STATE
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DESCEUas aoxr� ��rxc nor��:
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stzE oF z�zov �h-r r��xcz�r , wmrx r�rGxr � Fr
R4Q _� G �f � � HdUSE dNLY � l_� ` SASEN�IVr �o _ G SIt81�¢t:
NZJMBER OF SQUARES � �"iOtJSE & GARAGE �-�7�Q t. P.x;ating F'tonr Ptm,
Sa�� � A;C[iED GA.RA:GE 2, �lropaaed �oorpl'n
PROPOSEI� sT7.E: • o D�Tt�C�D GARA.CrE 3. LiBe af sauctrorcsl rnembeis to be �ed
PROPOSED HFZCHT:
� FOR Iv�w CONSTRUCTION INCLUDIIVG DECKS,
❑ �•„��i QS,� nnnmorrs. � po�c�s �?��r:
❑ Ahimmum O Trun t. Site Pia»ISorv�y �hosvirtg the exi�;ng spvea�
L] UFhcx Li YdSMa "�d �`9P°R� p*'O��'
Z. T'wo aas of coasn�actiaa ptaas
wi�rows 3, Et+aBYGlcWetim,s
itv E.�t75�TNCY OP�NT,+IC.S oX� ONo �,OCA,TION OF �Ai�OWS F4R WlZ�T10w3 -x";LO�� U-VhLtiE ANb
OP�FOF NEaV OPENINCi3-DE3CRI8E 3IZE OF �,T ,�_ . ____ MAI�LJpAC?iJYtE 57IC11'PR. ON WiTiDCiW.
OF'ENING CHRNGES &
7'YPE OF wzNDOR� TO BE INSTALLED Ni�M88R OF WTNAf]WS
AT.T. FFF.S ARF RASF.n �N VAT,IJATTAN, TKf.'tXTTli3vf:'C'C�: t'(1.�' OF I,ABOR AND MATERIAL�
(USYNG T'HE I997 ii.S.0 FEE SCH�AiJx.�)
�ermit Foc
Plan Review
Fire Svr�hnrge
Su�h�atge
License S�chatge
Sa4.G �hargc
Curb Gut Escrow
Erc��ioz► Con�ol
Park Fee
Sewer iv[� Gttargc
Totsl Due
9co i3aak rage for Z'ee S�hedulc �,
65°!0 of Building Per�it Fee
.ODI times the total job'valt�&tion
•l1UW x YC�riut VBh�atian �mriitt $S.OQ
$5.00 (State Licensed Residettitit�l Conhsctozs}
$2230 per SAC Unit (Plans t�o MWCC for detvtmmation)
ft + 6 �t = „_,_� ft x $25= $
$45� Canservation p�an Review
�'e� L'fClenniucd by Engisieering
Agr�ecmcnt necessar3` ( ) Nan Ncc�5�5�Y ( )
A�sice che�ks va,vable to: �iiv of Fridlev Attse
I'H151 � AN ,AJ?YLIt.'Al1UN FOR A PERMIT T70T VALID UN'IiL pROCp,$$gD
I hereby apply for a building pez�t eaad I aclmowlcrlge that the informat�� ��ve is r,pmplete and accivate; tt�at tl� wazkk will be in
conf�rmsnce with ihe �rdznaixces and codes of the City of Fridley and wit4� t�.e Minn�sota Construction Codes; tb;st I uaderst$nd this is mot a
pc�nn out osuy an appucauon ror s p�m�t ana work is nvt'to start withouc a perm��z on site; that the work will be in aceo�nce with thc
a�proved pia» � thc Case o�i work a� quff€s review and approva] of p r!j
SiGNR3VRE OF APPLICAlv7���� PRII�1i NAME Q,�J�YI 3'��1 AATE �;�f `1._ _
.�Pfi�tovp.�. IIrrsn�c�roR �rc n' -
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