P - 35091�
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Ynspections
763-572-3604
763-502-4977 FAX
DA -
SITE ADi►it�SS '
'C'kIlS APFi.ICATI'i CS:
TENANT
$UILD�G
RESYb�EN'�'IAL Al''p�ICAT`IUIV�
CY'TY Ok' FRYbLEY
LFFECTIVE 1•1-2Q11
C] OWN�It
sua�ur �► corv o� sTnrs
vvu� srAr� �.�c�rrsE
AND CEtiTYFTGA.'tE OF ADDti�
IN�Ci�At��1E Pttc3t�
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DESC�ttB� WORK BE1NG
NU� F SQUACiES
p�� StZ�:
F'RflPOSED F!E'l4iiil':
E�MAIL ALIARESS
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C�RT
!.E FAMf�.Ytt�ViW COt�}SritUC1'IOt�i
FAMaLY/NEW C4NSTTtUC710i+t
❑ s,�s�� Firr�sl� o �
o �� o srnmr�
SI '
O Vi�
❑ Alumis►um
� 4iher
N EJ�S 4pEMhl4S�ea []No
OR FOR l+fE�+i 4FENtNt`iS-DESCRTi3E S12E pF
AAE
Peim��t Fee
f�ian Cttview
Fire Surchargt
Surch�r�e
�,%e�s� Surahsrge
8AC Charge
Curb Cut Escraw
�rosion Conttol
Park �ee
Sevuer Main Charge
.
❑ I��US� ONLY
O HOtJSE & GARAG�
O ATTACTi�C� (3ARAGE
Q pETACHED GARAG�
Osoffic
O'�rim
O Eascia
LC?CATI01+! OF WINbO'WS
I999 �J.B.0 FEE
'[1LE
perntit Na. .
Recei�ved
raee�iuRwT �MADEL'n+1� StIBA�IT'
1. Existing F10Dr Plsw
2. Ptopo�ed flaar Rt�
3. LiSt oP3u�tui�) memhen to be umeG
�OCt N�W C0�1S7�:UC'ti'ON 1!�L4ii3IN0 Lt�EC'�CS,
ADDI710NS & �+UR�S 3t18MfT:
3. S�Ee T�✓S►irvaY sho�ving ihe eatisU$$ �
au�d � txal�ct•
2. Tvvss s� af asnsnadiun Pie�
3. Et1o*8Y C�cu�ci�nc
gt]R Wtltli?Cl1?V'S — PF.�i'V'�E LLV.�i.� ANC►'
MANEIFACTtJ1tE $i1CTC� (?t�'WiT4[rc3W
65a/o of �uilcling Ptrmit �ee
.QOl timas tfte t�taf job valuatit�n
.pp(35 x Pcrmit Valuatiq� Minimum $3.00
$3.00 (State C.tcenscd Rcsidentia�l Ccyntractc�ES)
5�2230 per SAC (J�nit (�lans to MWCG for determinatio�)
ft+6ft= ftx$25�$, —
$450 Conservation Plan Review
Fee }�term�nsd by �ngineering
Rgr�ment necessary { } Noti Necessery ( )
Make che.cks uav�6)e to: Cit;v of Frid�cv Ai�
� TFIIS IS AN APPC,YCATfON[ FtiR A PERMI f-NOT VALID liNTii: pAL1C�SSED
I heretsy �Qly for a building perrnit and T�cta�owfettg t the informsiicm aba've is complel� �tnd a��; that the 'w�'k will he in
confo�mar�ce w�th the ord�nanees and codes rsfthe City �' dley and �vith the lvtir�nasota Cans�tctit►n Cades, tk�t I�ndars�nd this is not a
pctmtt but only an $ppliostion for a permit ' n to start witl�aut s p�rmic on site; that t�e woric wiil be i� �'+i�ae wit� fiu
appraved pisa fn the case al hich uir " and approval of p f��., �a�c_. 7'"��"�'f
Stf31�1wTURE OF APPLCCAN t�l�C' Nhlv����.�./-�i��
W�80�L004 L60Z/Zl/L:al�a Z/Z:a6�d 8l6£998ZL9:wo��
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