P - 45104�uilding
Tnspections
� 63-572-3604
DATE �[ I L f� j
STTE ADDRESS � � �
THIS APPLICANT I5:
BUILDING
RESIDENTIAL APPLICATIOl�I
CITY OF FRIDLEY
F7
❑ OWNER
�'Rt��ERTY OWNERJ N�: KQ
��
TENANT p,�DRESS: 7 �14
CONTRACTOR
SCJBMIT A COPY OF
YOUR STATE LICENSB
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRrBE WORK BEING
YQUR E-MAIL ADDRES�. O�� S G� Q
! tircf� N .
'QCpN'I'RACTOR
t/ � o l,� �
( W r C r/� C CITY�
/��t9 • aoy
��,� I'HD At- Home Services, Inc.
sT,aTE Lic 2690 Cumberland Pkwy, Ste 300
���ss� Cumberland Office Park
PHONE Atlanta, GA 30339-3913
❑ s�GLE Lic# 2026$257 Ph. 763/542-8826
❑ TWO FA •
Q ADDTTTON ❑ GAR AGB/SHED
� BASEMBi3T FINZSH ❑ ROOF
O DECK ❑ SIDING
❑ SWIMMiNG POOL
❑ NEW ❑ ADDITION
lREPATR ❑ REMODE
�1 / i� (�O 1 w S � A
q sa� 3
CITY_
�E
.ORIES
"'9. WINDOWS
❑ DFtf�IN TILE
❑ OTHER
Permit No.: w�!
Received By:
D ie e' �,
�
� �,� o n,r s. �o M
�STATE_ZIP s S �i .� �
F�dtr Jnn< �_
YS- C.o47
STATE_ZIP
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT ' S. Ft.
�OOFIIVG ❑ HOU3E ONLY
NTJNIBER OF SQUARES ❑ HOUSE & GARACTE BASEMENT REMODELING SUBMIT:
1. Existing Fioor Plan
sARAGES � ATTACFiED GARAGE 2, proposed floor plan
?ROPOSED SIZE: ❑ DETACHED GARAGE
'ROPOSED HEIGHT: 3. List of structural members to he used
;IDpvG FOR NEW CONSTRUCTION INCLUDING DECKS,
7 Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
� Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
� Other ❑ Fascia and proposed project,
��INDOWS 2. Two sets of constnsction plans
3. Energy Calculations
N EXISTING OPENINC:S'9�'es �No LO�ATION OF ��O� g' p� �, ga ,�h
�R FOR NEW OP£1�IINGS-DESCRIBE STZE OF i v r n 9, !7
�t ENING CHANGES & �
�YPE OF WINDOW TO BE INSTALLED D%� S NUMBER OF WINDOWS
ALL FEES ARE BAS�D ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIA.LS:
(LTSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATTON $ J�' 3�'1 � OCCUPANCY TYPE
'ernut Fee
'lan Review
>urcharge
� ire Surcharge
,icense Surcharge
�AC Charge
�LliG l.lif �SGiUVv
'srosion Control
'ark Fee
�ewer Main Charge
'otal Due
$ t vl S.� i' See Back Page for Fee Schedule
$ 65 % of Building Permit Fee
$ ..?. ` 7 (A005} tunes the total job valuation — Minimum $.50
$ S. 3�f .001 x Permit Valuation (1/10%)
$ S. D u $5.00 (State Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MWCC for determination)
,n fzro:Z= �x n2G= n
$ $45Q Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$/ 3 8.? L Make checks payable to: CitY of Fridley Attach
ulations
THIS IS AN APPLICATJON FOR A PERMTI'-NOT VALID LINTIL PROCESSED
hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
onformance with the ordinances and codes of the City of Fridley aDd v�rith tl�e Minnesota CQnstructinn. Codes� that.I,understand this is not a
ermit but only an application for a permit and w rk is not to start without a permit; that the work will be in accordance with the approved
lan in the case of all work which requires revie clapproval ofplans.
IGNATURE OF APPLICANT � PRINT NAME i r T- f S r,+'� �� DATE ✓[(�° ` r r