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From: 6517715052 Page: 1i3 Date: 12/13/2010 9:2821 AM
B`i��,�i��i
�.E�IDENTIAL AI�P��C.A,T�UN
��'�'X �JF` �RIDIJEY
S(17U� �-NIAIL ADDRESS
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�] OWiv� �NTfc�ACTOR
szA� L�c�vs� #
F�LL rr�r •r, ¢'r�' [
at�37� �7
r 'JF S,�.t
°7 I � �5i �i
� Sfi1GLE FAMILY/NEW GQ�1S'�,RUC�ON
Q �'WO F'AtvfILY/NEW CONSTRU�TIUN
�7 �3�1.5�ME�t PINISH ,�7[ROOF
❑ T�£G�C O SIQINQ
0 5WiMM
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IZE
TORIES
❑ WINDDWS
❑ DRAFN'iILE
❑ O'THER
TYIyE (i� WQ�K.: ❑ 1�� TdOMk CONSTRUGTION Cl AAC1I�'IOaY
�'MAINTEiVANCE1.Rk,i'AiR CI REMCfDEL! G
��.s��.z�e waxuc �smra oot��� � '�1-� i
SiZE OF ItviPROVEMENT LENGTH WIDTH
�(7bF1N� �[ HQI3SE ONLY ��
rau�s�� ok sQvA��s If� . 33 �� ❑�tovs� ��axaa� y,' �
*A A G �.� 0 ,A�'C,A,G��A GARAGE ��
PROP05ED 51Z�. CJ .D��',AG��7 GARAGE
pRaFOSED NEIGHT:
��
❑ Vinyl
❑ ASuminum
� Other
CiScYffit
�Frim
�ascia
W FNl40w�
� P7fJS'�NG OFENINQ$ �SCes t.lNo LOCATION OF W1lYDOWS
4� �O�i b1EW OFE1viNGS-DESCRIBE SFZ� Q�
C�Q1EN1f�rG C�1[ANGES �
TYPE OF WII�7DOW TO �E �i$7ALLfiU NUf+���t �� �
ALL FEES ARE HASE� 0�1 VA.T,.UpTIQN,INCLUD]
(LJS�IVG THE 1997 LT.B.(
"OTAL JOB VALIJATION S �����=�� �����r'l
Per�ait �ea
Pian �2eview
Fire Sul'Ck�a�rge
Surcharge
�.iceztse Su�ohaxgo
SAC C�arge
Curb Cut Esorotiv
Erasion Control
Paxk �ea
Sewer Main Charge
Permit No.: p� L � ���
Rece�v�d �y: �'"'�'
��c��'�a� � C
�z��i „zcp.��
�i�/2.. __
��ST.4rE 1✓� M ZIP
EASEMEN'I' REMaDFLxNC� SI38M1T:
i. Existing P1oM PI2it�
2. Y�posed flaor plan
3. List of struchu�l members to be useci
Fdtt AfEW CU�IS�'}idJC'�o�V [NCLUI?IN[? D�CK3,
AC]I?I'x'�ONS. & ppRC�S SUBl4d„2�'•
1, Site �]aR�S�rvey showing thc cxisting s1YUCtUIes
and praposed praject.
2. Two sets of conshvcrion plsns
3, E�aergy Ca�culac�ons
ECJR WINDOWS — PR(7VZA� IJ-VALUE AND
IvtANUF'ACT[JxiE S'x'iCICER.O�i W�I�TJ7aW.
+TU '�E �OST OF i.ABUR ANI) MA'
FEE SCi��DULE)
$ �4!' ! ac� _, See Back Page for �'ee Schedule
$ 65°fo of Building �e�rttait Fee
$___ � s.041 times the tota� jab va�uat;on
$ � ��, .0005 � �'e�lxAat Vajuation Minimum $5.40
� �'�� � $5.00 (State J�xce�sed R,asidential Contraators)
$ $21 UO �er S.A� Unit (Ptans to MWCC ivr decernni�at�or�)
$ �} + 6 ft = ft x $24 �° $
$ $450 Coz�scrvation Plan Review
$ - ---- - - Fee Determined by E�g�neez�iz�g
� Agreernent �ec�ssary ( ) Ndn Necessax� ( )
� il �) rt ,�� MBke checks uaw�ble to: Ci#v af Fridlev Attac�►
'�8 xS AN APPLtCATlON FQ�L A QE��'�-NO-[' V AL[D tJNi'!L PR�7CESSED
E hereby appty �'oK a�uftldxag germit and 1 acknowledge tt�at tb,e Fn�'orsnation sbo�ve is comptete a[�d accurate; th$t the work wil] be in
co�formance with the oxd�iz�snce5 a�d codes of the City o£ �'rtdley at7d with� t�te �innesota Con9truetion Codes; tk�at I urtderstand this is not e
pe�xait but only an spp3ieatio �ox a�eczrnit and work is not to star[ without a perrnit on siee; that the wark wA�� be A�. acco�rdanice wi,th the
approved �la�n xt� �e case of work wl 'o � wices xeview and approval ofplans.
S�GN�ATURP OF APkL3CANf PRiNT NAMSE �.[� / C� �f iS�1 DATE /o'��l. 1D
ARVRCfVAT. TNSPECT(�R SiGNATIIR _ 1n; / J �
'ARA,'�'� P�RMi�S ARE RE�iR�T� Td�t l?}�UMBING. ELEt,"TRICAL AND MEC�.A.�i�CAL WORK