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Inspections �SID�NTIA�r. APPI.YCATXt�►N
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`C�1�EANT AQPRESS:
' PHC�NE:S€',1, � -.
�O1V'ii�AGTOR �iAMk:: fA
S[�L�MP�' A Cc��'Y a� srA�TE LiGE E
Y�UE� STATF LICENSE
n�a ccRTlFr�aTE o� np�RES�:�
PER;MiT TYPE
TYPE
DESCit1 R1F
512E OF iM
0 5ChIGLE• FhMll:
Q TW� FAM1l.YfF
o BASf;MCNT FINiSH
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IN F.XISTINGaPEhlll�tC1S 0'Ycs C]No
E)R FOR NLW pPENiNGS-D�SCR[SE 512E Of
C�l'F.1VlNG CtiANGE5 R
ALb FEES AR�
P#an Review
Fsre Surchar$C
Surclyar�e
L.icense �urcharge
SAC Chacge
Curb Cut Escrow
Erosion Control
1'ark Fee
Setver Main Char�e
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RUC'1'if3t+1 SIZE,,.,,_
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CI Tri,n R�A�10i�ED? fl YE5 ❑ 1�0
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LOCAt14N QF W1N��YS
T�Y� 1997 U.B:C FEE SC�EDULE}
Pennit
�teceived
_ S7'AT�,w,_?;[P'�.,�„�t
�rt�►'� .z��,
FiL• IGHT $Q FT
�HSL'��ItIV! RL'141�J1JLLtuU.lt�lllllll.
i. Gxis[ing Floor �18n
2, i't4pased itoor gisn
3. List of struotural rnembers to be uscd
EO1R AlEW C.ONSTIttJCTlC?I�F TNGLL3DINC }?ECKS,
All ITYt3NS & P t€C1±�5 SUE# 11"
l. 5iu pian/Survey shawing t!x exiStmsSsttuctures
and propoSbct ptttl�.
2. 'iWO Stts ofcGnSUUGtion p1anS
3. Energ,y Galculations
COR w[NCtOWS � PRC)'YIDE tJ-VP.�-uG,0.ND
MANLfFACTl3RP STICK�� AN W[NT�'t�U.
- — --
$ _ See �ack Page for �'ee Sch�dute
$ 65%af L�uildin� Permit �ec
� � --- _001 times the�total j4b vaiu�tion
$ .4405 x Permic'�Ialuatian Iwinimum or ,50
$ $5.Q0 (State I�icensed Residentiat ContrflctoYS)
$ $2�G5 per SAC Un�t (Plans ta MWCC far determination)
$ i�+bfi= ttx$�5=$
$ $454 ConServation i'lan ltevi�w
$ F�e l�etcrmined by Etiginoering
� _ Agrterrsent neccssary ( ) Non NeGessaty� ( )
TH]S tS AN AP�L1CAil4N FOR A PCCilN1T-NU'C VAL1DtJN'1'IL PRO�E95tiD
{ h�reby appty for a buildit�� permit �nd l acknowledge that the inf4rmation atao've is compfete and �ceurate; that tbe work Will be in
conform�nCe with the ordinances and codes of thc City of �'ridley and with t�e MinncsotA ConstruC[ion �oci�s; th�t [ understand this is not a
permit but anly an ap�lie�tion f a it and rk is not t4 st2trt wiihout a permxt on site; th�U tht wc�rk will be i� accnrd�n�e with the
e�pproved �lan in the case,,faf , ich r v' w and �PPraval of plan.r,�;����� ,/ �
SIGNAT[TRi OF APPC.ICAl`� �` _ PT{INT NAME lsi� �va ! �ATG_'T l�- r.L�
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