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P - 45102�U1��.121� �i1S�]�C�10�'I.S 763-572-3604 76�-soz-���� ��x DATE � e:C-.1 �''t I I s�� a.�a��2ss �! L 7�[$ A,P�L�CqIVT 13: �'�O���tTY UWN�R/ �'.ENANT Sl1BMIT A C(�PY' 0� X4UR S'�'A"z'E LiCEi�iS� ,4rm c�xTT�c�,�r� a� MSUAAi�iC� ��tO�ERTY TYPE FE�r�x�� 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 .i r— � . . �] 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 v� �xr z�.�'x'� t�3 C]Tll � FAx In..�i J . � 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