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P - 44223From: City of Fridley To: 65125B1064 Page: 2(3 . Date: 8/10/201Q 9:Q8:47 AM $Uildillg Bi�ILDIN(� Permit Na_: �`� �u Z,��' Inspections ��IDENTIAL AFPLICATI�N Received By: 763-572-3604 C'jT� f�F FRIDLEY Da�e �ec'ci� lb 763-502-4977 FAX rHr•�cTiv� �-i-zo�o llAT�:�(j�� I�� CO/ dj YOUIt �-MAIL AUUK�:SS V rKI�Q_e�y�/'/d� E.�iC�Y'fs,�� ,i'�' SITE: AD[iK�SS ��J'��C�� I �Ll�i� �� THIS APPLICAIVT 1S: O �WN�.It �f7NT1tAG"TOIi PROPERTY OWNERf ��M�: �P�TTI�1 ��1 TENANT . _----___ � �...,. � - D --- . .. sveMrr � ca��r c�F YOUR 5TATE LICENSE AIti1D CERT{�ICATE f1F (MSURAIVCE PRQPERT� TYPE TYPE E3� W(3R.K: ur:scKis� w�ax ��uc= vt s��c� or• iMrK�v�nn�:� KOQFt `Y4 NUMBEK OF 5QUAytES � GANAGt:.S PRbP()SED S!"L�: PRf7P()5�ll HkIfiHT: � STATt LtGENS� # ��d F UAtE �Ht��r� bJ/—�b ;�Ob 1 r��.�?� .�i�= O S[NCrL� NAMt1LY1{WH,W CfiNST1tLlCTYf1N SI"L.� ❑ TW(? �AM1ZYrN�W CCINSTtitlCTt(}N ST�itIES � A13111Tt�T+1 ❑ C,A�4��1S1i�i1 l�fL)(3WS F7 k3A5E.t4l�hdT i�iNtSkt 0 IZ(7�5H C7 [7R!#►N i'iL� ❑ Gl�GK � SYlliNC; Q fJr'iFlElt. ❑ SNr'tMh4El�Cti Pf�L �� EVJ kil7l�h�:CflN$TRUC"LtOPd � ALIDITV[YTV ,ai�u��:r�,4r�c�r��pxzx � ��n�mn��uc, IV 0 Yi�yl ❑ Alunvnnm � Oiher !V 1 �,�r W �XISTING OP�NiNGS ap,Yes QNn CNZ HOK N�th' nP�NYIUG�U�S�121i3E 51i:C 4)k OF�hIING CHANGES & _ . ALL FEES ARE B�lSET1(J�N TOTAL .TC)rB VALU�,' Pcrmit Fc,'c Plan Itcvicw Firc Surrhsrgc Surchargc Liccn�c Surchargc SAC Chargc Curb C�t Escrow Erosian Conttol Park Fcc �SCwcr Main ehargc Tot�ll Due �.�r�rs�. � r�i�us� a��v�.x Li Hf1US� &. G.41tAG� 0 ATTAi"i3Ei}�Ait.4Cst � o��e�� r.,a�ne� Q.�i(Lt�it �' T�im Cl F'�.aeia Lf7C:ATCt1N OF �V[N[�W'5 Tk`�ZLP� T�;�%utP � HA^��MENT Kf:�4dU�LEh[€'r SU�MIT': !: kacr�ti�xgKfoofPlut 2. nrnpp�ed t�aor pf4a�► 3. E.ist of aEr►�hmC members ta be �� F(7RN�1� C(}tdSTR:l1f."Flftht il'�LU6JtM1tG 23E[,'KS. AE3DLTI(II�tS. & P€}Y�kt�S �BA�tt"� }. St6e PlanlSlm'Cy sixnwi3tg HAG eziS�hng �roCNYCs and �m}'ttrsed �roject Z. Tr��ct seis ntrnnstrt[ctioa planc �. �nergy f'a�u�timt� Ft7K W`6I+EEn7WS- E'Rf1�tU�� U-V.M1LUk Ahlil Mt�NUt�ACTUIi� STI�iG�R4N WINDQW. f► ( rrunt��.x. c�r ��r��c�ws t [ �LLIATIUN„ INCLUD[NG THE �f?ST f3F L.A.BUR �NI? MA'�"ERIALLS. US[NG TtlE U.B.0 E S��DULE� � � "/�� I� UCG'UP�4I�TCY TYPE 'U � .�- :,' Scx:, ack Pag� far Fu�c Se1�c;dulc; $ 65`%'a af Buitc��ie�� E'c�tnit F��c; tc � Ca .t�I iiirxes th� toia� job valuat�an $ � ,, � ;,— .� x E'crcr�if Ya�aratia�r Mini�num $.Sf� � � /,Zv �55.(l0 (Sta�c Licc�t5c,d R.csi�ic�ttiat t�antracta�t) � $ZlUO �r S�C tl�it (P�ans ta M1�fCC for dc,�inatian� $ ft+fif�= ftx$24=� $ �;45@ �anser�aticm Pi�n F�c:viu'w � Fc�a DYCtc�m��:d by E�g�nccring � �4grcemc:nt n�c�,�ry 4 } �tan Ncc�sary ( } � � '� . [J �Vlake eh�ks R��a�e to. GitY eri �ci�y �ttgch �rttx� r:�,a�v r��.tc;aryc�r� r•t�� Fttt�ttr-rtc�r v�.,iu uru�r�t, p�t�'NSSr:c� [ hcrebY apply fc►� tsuelding pc,m�it nd L ac�Cnaw%dgc t�at ti� i�tf`e�rmatian ab�vc is eo�rsptctc a� �ccucaiL; titat �itc woric w-iti bc in conforrnane.� with � arc�inancec,,.�+; arYd ofthc �ity c�FFridic,y a�d �ith thc Minnc..�ta �o�nslru�tiam �oci�,.�+; d�af t und�rstand this is nar a permit but o�ty a�tication for a rmi: nd wack i� not fo ��tsrt withaut a pennit an �i�c, tltat t�se war% will bc ia► accatd�rtwcc with t�tc approvcx� �alan in ca.sc af a' w ui� icw and ap�r�aT nf I� � SlGNATCi�EC)F�AIPP�.t �� PR.�NtNAMti�1A/�N LI / FJ.4T�i ��'�O ` ` I�E:�A� �€f:1't� ��TE'E}`��1'C� �4R� R��t:��[��`SC�� E�`��h��i�, ��'t�1��L �I[� ��-i�i[€>�i4t� fi�"�F� �� : -..'