P - 48052Bui�d�ng
�riSpec�xoz�S
7b��S72-360�
763-502-4977 F.�
�>Al'6 �O � ( � �
51TE ADPKESS . .� �t? a •
THIS APPUCANT �S
PI'tOP�RTY OWIYEF
TENANT
From: unknown Page: 2/6 Date: 6/212011 10:42:52 AM
�i�(iII,���ii , Pertx�itNo.: �i'G �,��,�(i �1 ` �
�'ESY�E�TTIAL �PPLIC,A.T�ON Received By_ ` 1 �' 1 ?
CT'�'X U�' FR�II��Y �a�t�"�: � � �
EFFECTIV£ t-i-2011
_ YOUR E-MA[L ADD�iFSS �„s ��' °► w« r•: Gs.-� w,+�Si' 1 N� • 4�'�
ra�� / '4" 1�'
❑ OWh1ER �ONTRACTOR
1 f'Q'1�. SO M�t Y'G�' ��-G.
i�6D NiCP�I-GT �►1/�'�-t— � �rTX � � STAiEI�nl_y�p'� 5+�il3
yy�- ��� -,�s��
CONTItACrOR I �p��; �wv�r� �� w w �5r �N �-
SIJBMLT .A C4PY C)F i' �,�E,�p G�RT NUMB�R, N� —�� �� 1!
YOU�t STAT6 L.tCENSE! � sT�� �-�c�trse u� o'� S� 5 S L
ANDC�RTIFICATE�� � �DDRESS: L�s'-��I CaAdri�-1n. C!'�'X S!. GeRa,tb P� STATE�NZ1p��P�'W
CNSURAIVC� PHONE � l Z. � $'7 � — C�3�i,� �',AX L � L"' �'tir � � �'�t,c�
I�ROPERTV �"XPE :: � SINGLE FaMlLYmr�w COMSTRUCTION 5�crc,,,�,_
; ❑ TWO FAMILXI�IbW CONSTRUCTION STQRJES
FERMiT T'YPE
TY�� l7�' WORK:
ptSCRIBE WOItK 8E1tvG
R v
�vltMB�R pF 5QUAR�S _
GA RASi.F,.$
PROPOS$D SIZE:�,,,.
PROPOSED HEIG�T: _
StDING
!� Vi�Lvl
C7 Alumioum
O Other �
�V{;� W
IN EXiSTlNG OPENtNCS
OR FpR NEW OPENINGS
OPENING CHANG�S &
ALL FEES
'OxA�. JO� VA,I,U
Permit Fee
Plan. Review
Fsre Surch,arge
Surcharge
License Surcharge
SAC Charge '
Curh Cut Escrow
Erosion Contro)
Pa3�E: Fee
Sewar Main Chargt
'�'o#al pue
❑ BA,,SEIvI£NT FIN15H �3ROOF
C] p�CK O SIaING
❑ NEW HOME CONSi'RUCT[ON ❑ ADD1TlON
❑ MAINTENANCk:11tkPAIR �.REMODELiNQ
18{HOiJSE QN4Y
LI HOUSE & GARAGE
O ATTACHEID GARAG�
II LlE'fACWEO GARAGE
Q$Of�I
❑ Trim
� fsscia
L3 C►ttA1N TI1.E
Q OTH�R
❑Np LDCATION OF WINUOWS
2J8� ST2� OF
�LLEA NUMBER OF WINAOWS .
�SED ON VALUA,'��Q�1, x1�iCLUDTN'G 'CH� COST QF
(yJSYNG THE ]997 [I.�.0 �E� SCHEDUL�)
� y7 � 7�]D "� �CCIJP,
�T REM(�„DELING 5UBM1T:
1. Exisiing Floor Pian
z. Proposed floo� ptan
3. List of struccura) mcmbers ta be used
kOR NEW CONSTRUCTTON �NC4UbtNG DECKS.
ALID[TIO'NS. & PORCHES SU�MyT,
t. Sice P1sNSurvey showing ih� ex�5tiog StNCtures
and p�npos�d proiect
2. Two sets Of canstruction p18ns
. 3. Energy Cafculatioro
FOR WINbO�VS — PROVJpE U-VALUE AND
,MANUFACTURE STIClC�R OT► wINDOW.
,AND MATEit�ALS:
$ ��,� j See �ack Pag� for F�e SckXedule
$ ,� 65%ofBuiidin�PermitFee
$ .00I times the tqtal job vsivation
� j��' .0005 x Pcirnnit V�luat�ota Minimum $5.00
$ _�� $5.00 (State Licensed Res�dentiai Contractors}
$ $2230 per SAC Unit (Plans to MWGC for decerminatiorl)
$ ��6ft= ftx;$25=$
$ $45p Conservation Plan Review
$ �'ee petermined by Engineersng
$ Agre��ment ttecessary ( ) Non Ntcessary ( )
e i . lwstce checks aav9ble to: Citu of Fridlev Attac6
THIS IS A11 APPUCAT(QN FOR A PERMIT-tJOT VALIA U�U-'PROCES5ED
I hereby apply for a b ilding pe�xnit aclmow[edge that tkls info�rtuation above is eoim�lete and accu�ate; that the work wi11 be ir►
conforrnahce with the oFdinances an�d cpdes the City af Fridley �and with the Minnesata Gonstxuotioo Codes; that 1 unders�tand this is not a
penriit but qnly an application for a permit d qrk is not to start withotrt a per�nit ot� site; that the wprk wi#1 be ip accqTda�nce wftth the
approved plan in the o o Il w w"ch cs rtview astd appmval of plazts.
SIG�AT[iR� pF APPLfCA, PRiNT NAI�E_ v��!ti�'�� ��i�M'"�"p�ZE �+ � � ���
qPp�OvAL INSPECTOR SIGN URE �
1�
a