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P - 48316$U1�C�,1I1,� ����,,�]��[i Permrt No_ � � � � Ynspections ��Y���TYAL Ap:PL�CA'�ICIN Recei�ed Ey: � � ��3-s�z-��o� CITY OF FRIDLEY D 763-�02-4977 �A� �����:i ��; `�� � '° �',�' ' EFFECTIVE 1-1�2012 DwTE � _ YUUR E-MAIL ADDRESS SITf ADU ESS �� ��� i--.Gr.-�JL . T[iiS Ap�LTCA]VT i5: '� O�l'NE2t �OAITCtACTOR �'120�'ET2TY OWNER/ � {� ��NA�NT NAMF� . ���i1!,�'9_,�"�� I nI �jt' � tiS:�, 4�'D CZT'};' ' STAT��IP \ll W PFiONE: �% ��J — ��I � " S � � caN�rxa►c�azz rrAMa: �uc�, S[7�MiT A CQPY O� STATE LICHN55 ����Q��ts 1��OV� D�lw bX,�AO C�R'f NYJh(IB�IEt \' ��S �� � _�` �� � vn�rn srAr� �,rc�rrs�, �y� 1 �^-'' AhI17 C�RTLFICATE OF AUDR£SS LI lM �� ��' �• �c.,9.�1. 7m CiTV !-�+�La�tS� STATE 'f.�ISCJRA�NG� Px{CiNG�J�1J` -^^ '�� FA7C ° � `�..� � � FROPERTY TYP� 1�s��GL� x,�iv41T.'4''rNE.w CGNSrt�T7CTFO?�T S72E C7 T4V0 FAMIX�YlN�1� COr7�'1'TZ�1CTIpN $TpkT�$ PERMTT TYPE � ADDITION ❑ G,4RAGE/SHED Wfi1DOWS ❑ II,�SE,MEIVT FINISfi C7 RGC�F DRAIN TTiE ❑ T7�CT� C3 SIDING ❑ OTHER ❑ SWIMMINC'rYUC?L T`1rP� �F W[IRTC_ ❑ iVE'VJ �TOn� CGNST�rJCTiUN ❑ A17nr'ttr�N � Z L.L��� �1�4 c't-(�la ❑ M,4TNTENANCEJit�P.4IJ2 ❑ REA4QDELiNG � ]j�',SCRIBE WdRK BEING DONE: � � � � SY'L� O� T'NfPRd VEMEN7 LENCrrH WiLs7ii i-x�6kTT S F"[' 12U41�YN� ❑ HdUSE ONLY NUMB&R OF SQiJAk$S p��YJg� ��A�p,G� HASEMENT �tFMOD�LIN(* SlJSM1T: � ❑ ATTACFiED GARAGE 2. p posed fl or p19n P�OPOSEU SfZE: ❑ I�PTACHED GAR.4GH 3. �ist oFstructural membera to be ueod pit01'OS�b �T�TGT-TT: stL�,Ct+1G Fuk NEW LONSTRUCTION INCLUDIh'G UECKS, ❑ Viny1 ❑SotYi[ SILIING/50FFIr/F'ASCI.4 ?�ppTTidNS. L� PQRCHES SLJSMIT: ❑ Aluminum p�k;� �����p� ���� � N� 1• Sice PlanlSurvey show�'rrtg the exrst'rng struccures ❑ Other O F2seii� a+�d propos�d project. ��� ���`� 2. Tv�ro scts of cottecruction plans ��d�'�'� t 3. �nergy Calculatians CN ��TSTrNG OPENiNGS i'cs �FJo LOr_qTT�N 4F iNI1+iUOWS k"k' �.lr%� F4R WSNUOWS —PiLOVlb£ YJ-'�/ALi3� AtJb 4k FOR NEW UPENiNGS- ESCRTEE SIZE D� ,�: TQL�`th MAN�L'i�AGTCT�E S1"iC��12 ON WiNDQW, UY�N1N(iC:TiANCx�S�c i�'j�'�� �j,� T�F, OF WTNUC�W TQ EE TN$TALLED N�rIvIBER OF WiNL10W5 A'LL FEES ARE SA�ED ON VALUATION, INCLUDING TI�E COST O�' �A$�UR ANb 1�A�.'�'��AY.,S: 'OTAL JO� `VAY.,(7ATTOIV �e�lit Fe� Plan Revie�r �ire Surcharge Svrchargc T.icense Surcharge SAC Charge Curb Cut �serow Erosion Control Pazk Fee Sewer Maen Chargc 'I'HE 1997 U.R.0 FEE SCi��btiTY.�) OCCUYANCY 'i'YPE Scc Bac3� Pagc for �'te Schedute 6S°/u 4f Buildin� permi6 Fec .QOF timc� d�c total job valuation �.U�OS x permit Valuation Minimum or .50 $5.00 (State Licensed Residentiai Conteactors) $2365 p� �,�,[; Unit (Plans C�l 1��VCC �'4r dC�Cr*ninatinn) ft + 6 ft= ft x$25= $ �450 Consezvatiozx �'la�x k2eview �, �_ Fee Detarixvned by Enginccnng Agreement necessary ( ) Non Necessary ( ) , Z MAke checl�s �avable to; CfYV af Fr'rdle�v Attael TX[TS TS Al1 APFLTL"ATION FOR A PERMiT•NpT VALID UNTFL PROC�SSF.b I hereb� apply far a bu'rlc3ing permit and T aclmowladge that the infa�ation abavc is complete and aecurate; that the wor!€ will 6e in canformancc with thc ardinancts and codes af Che City of firidle� asld vtYXth i.�.e XVlznnesot� Constr'uction Codes; that I undcrstand this is not a permit but only an applicatibn for a pem-►it and work is not to sCarC without a perrxiit on site; tiaat the r�vorlc will he in accordance with the appraved �lan in the case of o� wl ��C� rcq�ires re�vi��c7�r 2nd sppr0'vgl of p18� � C } �g� Si('iN.4TUR� OF APPLICANf �`�\Z,�,��T�a P�2]NTNAME ��r '�i��l\� DAT� ����I� f APPROVAL INSPL'CTOR STC,I�TRT E ._PLEASE T�OTE: ,SEPARATE PERti�ITFB'AR�'1ZE�C7ff�U �'QR PT rIMBINCr. ELECTRIC.4L AND MEGHANfCAL WOR'[�, Wd 64 L£ Z ZLOZ/Ll/6 al�a L/6 :a��d 9900 LE9 OZ£ �oa�