Permit02014-01838 Permit NO. : I I I I I 1, 11 I I 111
CITY OF FRIDLEY * 2 0 1 3 — 0 1 8 3 8 *
DATE ISSUED: 08/23/2013
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
(763) 572-3604 FAX: (763) 502-4977
ADDRESS : 116 RICKARD RD NE
PIN : 103024120031
LEGAL DESC : GARTENS ADD
: LOT 3 BLOCK 2
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : REMODEL
VALUATION : $ 2,200.00
NOTE: UPGRADE OF KITCHEN AND BATH
APPLICANT BUILDING PERMIT FEE 83.25
PETERSEN RALPH S&KATHRYN PLAN CHECK FEE 54.11
116 RICKARD RD NE STATE SURCHARGE,BLDG VALUE 1.10
FRIDLEY,MN 55432 FIRE SURCHARGE 2.20
LICENSE SURCHARGE 0.00
TOTAL 140.66
Payment(s)
CHECK 8581 140.66
OWNER
PETERSEN RALPH S&KATHRYN
116 RICKARD RD NE
FRIDLEY,MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 180 days or if construction
or work is suspended or abandoned for a period of 180 days at
any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date