P - 48538From: 651 783 9050 Page: 1/1 Date: 3/9/2012 12:52:56 PM
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Building
Inspections
763-572-3b04
763-5��-�-977 FAX
STI'E ADDRESS
THIS APPL.ICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
- SUBMI'I" A COPY OF
YOUR STATE LICENSE
AND CERT�TCATE OF
INSURANCE
PROPERTY Z'YI'E
.
PERMIT TYPE
TYPE OF,woYZx:
���x���i Perrxiit N L(1 L%�;_�' .
R�5�33-ENTI� .�4:�'1'LI�A�TI4N x������a By: �
CIfiY �� �'�D�EY n��� �, , �: �:: <� �.' �u � ;
ERFECTPVEI-1-26I1 , 1�1._1,�� E,'vr
YOUR E-M.AIL AADRESS
❑ OWNER COTF'TRACTOR
>
:�ss: � S/� Gl�. Qi,e�
E7�3 5fia--s7��
STATE LICEN/SH # � G��
ADDRESS: 7 '
�HO� rAs� -r�� a� �
SINGL$ FAMII,Y
II TWO FAMTLy/NEW CpNSTRUCT'IOTJ
g BASEMEN'T FINISR ❑ ROOF
❑ BECK Q SIDING
C] NEW HOME CONSTRUCTiON
�?�2A�'TENAATCPJREPAIK
s-[�c.cic..a yy...-� .
' l T.EAD CERT N[JMiF�
'G�'L'� f•�p
FAX �OS�J L Q �
SIZE
STORIES
�sx�n ,Ja�W�rDOws
E] DRAIN T`II,E
❑ OTI�R
NG PQOL
❑ ADDI770N
Cl liEMObELING
DESCRIBE WORK BIING DONE:,( ���y,Q,yILQ.Lt� /.,�-�c..e,�,�Le-
STZE OF Ilr�PROVEMEIQT �G�
ROOF3NG ❑ HOUSE ONLY
NUMBER OF SQUARES fJ ROUSE & GARAGE
GARAGE3 IJ ATTACHED GA1tAGE
PROPOSED SIZE= ❑ AETACiiED CYARAGE
PROPOSED FIEIGHT:
3IITWG .
� V�nY� faSoffit
❑ AIuminum ❑ i'rim
C7 Other • L7 Fascis
w,mrnows - /
IN EXiSTING OPININGS QYes DNo LOCATION OF W1ATI30WS /-�
OR FtiR NEW OPENINGS-DESCR3BB STZE OF � s
OPENING C:HANGES dc � �
TYPE OF WINDOW TO $E TNSTAI.T.FTI i.nrn�raav nr iim.mnm
ALL
TOTAL JOB VALI
�....•�l�1.��..
�.
��_
� � !' /
�
� ` . ��
�� �. ♦
1, ExistingFloor
2. Froposed flooi
3. I�st ofstructw
FOR NEW �ONSTRUC7
1. ' Sptc PIan/Survey
aitd proposed prC
2. i'wo sets of cons
5L 3. �� ��►�,��
FOTt WIIdDOWS - PROVZi
��� MANUFAC7'URE 3T1CKE
ARE BASED ON VALUAT30N, ING`LIII�IN6 THE COST OF LA$QR AND
----- - 2.r,�iT�iNG T� 1997 U.B.0 FEE 5�EilULE)
�'��� ��� $ S� aj ,'�•-5 . See Back P'age for Fee Sc�edule
Plan Review $ ' 65°/a of Buiiding Permit Fee . .
Fire Suxcharge $ . L?d .ODI times the tatal job valuation
Surcharge • , $ � �,,,,-` .0005 x Permit Valuation Minimum $SAQ�
License Surcharge $ ,�'.6(� $5.00'(State Licensed Residential Contractors)
SAC Charge $ $2230 per SAC Unit {Plans to MWCC for determirsation'
Curb Cuf Escrow $ ft+ 6 ft= ft x$24 =- $
Erasion Control $ $450 Conservation Plan Review
PaTk Fee $ Fee D.eterrnined by Engineeting �
Sew�r Main Charge $ A�reeme�t necessary O Non Necessary O
Total Dqe � Make ehe�s_ a abla tu: C t►iFYidl , Atta�
THIS IS AN APPJ.ICATIOPI POFt A PERMIT NQT VALIIl UNTIL PROCESSED •
I heteby apply for a buildiag pemuE and I aclrnowiedge that the information above is complete and accurate; tt
conformance with the ordinances and codes of the City Pridley and with the Minnesota Constructian Codes; that I
permit but only an applicati r a permi and wo �s not to start without a ermit on sit ; at the�work will be
approved plan in tbe case o all hic 'e and a proval o-f pl� �% �
SIGNATURE OF APPLICANT itINT NAME `.% �L DATE
APPROVALINSPECTOTtSIGNA � —
-- SQ FT , LY/i�i/Y4
SUBMIT: ' . C
mbers to be used
INCLUDING DECKS,
JR3v1I'i':
�wing the exisdng structures
t
;Yion plans
U-VALUE AND
)N WINDOW.
the work wilt be in
derstand this is not a
accordance with the
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