P - 46270Building BUY�DYNG
Inspectxons RESYDE�ITYAL A.�"�'Y,YCATYON
��3-��z-3�a� CITi'" OF FRYD�EY
7'63-502-4977 FA� EFF�CiI'V'E 1-1-2011
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PROPER7Y OWNEW NAME;�i�
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COIVTRACTUk NAME: � �,
SUI3MIT A COPY pf
Yt�UR STA1'E LICENSE STATE �,TCFNSE fl�
AND CERTIFiCA1'E OF ADDRESS: �`Q p
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P/LO�ER1'Y TYPE tvit� i
❑ TWO FAMIT,VlNEW
P�RM1T TYPE ❑ ADDITION
❑ BASGiNENT FINISH
❑ llECK
YOUR •-lu�lAjlL AUDR�SS
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iW CONSTRUCTION
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� ROOF
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TYPE UF' WO�C; � O N£W HOMG CONSTRUCTI4N
DESCRIBE WK?RK BEINC
ROOFING
NUMB$R UF SQUARGS
GAR,►s�es
PROPOSED SIZE:
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❑ Aluminum
C3 Qthet
1VIlYDOWS
tN EXIS'�ING OPENINGS,�Yes ❑No
OR FOR NEw OPENTNGS-nESCRIBE S12E OF
UPEAI ING C HANGE$ �
TYPF, Qfi WINOOW TO Si; INSTALLL•D� t
ALL FEES AC2E SASECI OW V
TOTAL.tOB VALL
Fe[mit Fee
Plan Review
f ire Surcharge
Surcharge
l,iccnse Surcharge
SAC Charge
Curb Cut Escrow
Erosion Conttol
Park Fte
Server Main Char�e
Tata� �ue
�.�ACI �ERT NU��
Sr7E
STORIES
❑ ADDITION
❑ aeMOa���r,c
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❑ HOUSE ONLY
O HOU5L• & 4nRAGB
❑ A7TACHEp GrARAGE
O DEi'qCHED GARACrE
❑$�fFil
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❑ Fascia
LOCATtON pF WINOOws
,NUMBGR OF WINpQWS I
'IY, INCLUpIN'C TtfE CpST d�'
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❑ oRntt� TILC�
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Permit N
Received By:
� 5� '�L,
BASEM O E t T:
I. Existing Floor P1an
Z. Propo9ed iloor plan
3. Lis� of saucwrai rn�mbet� to Oe used
FOR NEW CONSTYiUCT10N [iVCLUflliJ('i pECKS,
ADDITtONS_ & PORCHES SC1i3MIT_
I. Site Pian/S�vey shawing the exisung structutps
snd proposed projett.
2. Two uts oPoptlsQuC[ion pians
3. Enetgy C81CUiations
FO12W)NDOWSwP120�'1DEU•VALIJ�qNi7 , ,/
MANU�ACTURE STiCKER ON W[NDOW. !f
flll'� ��l
� , t See Back Page for Fee Sehedule
� 65% of �uilding Permit Fee
� .001 times the tnt�l job vaiva.tion
$ .0005 x Pcrmit'Ualuation Minimum $S.OQ
� �5.00 (State Licensed Rcsidenti�! Contractors)
� $2230 per SAC C)qit (Plans to M WCC for determioation}
� ___,�__ft + 6 #t = ft x $25= $
$ $4S0 Conservation Plan Review �
� Fee Qetermined by En�*ineering
$ Agrtcment necessary ( ) Non Necessary ( }
$ /i Make r.hnek� nuvohlo tn• C��}V I�f riYl/II4Ya AMnn
T S IS AN APPLICATTON FOR A PERM17-NOT VAI.Ip UNTIL PROC6SS�d
( hereby apply for a bu;lding perm an I ac tdge that the information above is complete and accurete; Yhat thc work will bc in
conformsnce with the ordinsnecs and codes f e Ci of Fridley and with Che Minnesota Construcdon Godcs; that 1 undtrstand this is not a
permit but only an appticativn for a permii wo is not to start without a permit on site; Chat the work wil! be in aceotdt�nce with tt,s
approved plan in the case of r q'r iew and approval of pl / //- v�� l/
SIGNA'iURE OF APPLICAN'f ' PRIN1' NAME ,�if /.�� �/(/j6t (.� �,DA'PE
APP12AVd1.IWSPFCl'AR CIfSAt 7ItRF
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