PRE 2010 DOCSDate:
City of Fridley, Minn.
BUILDING PERMIT
d
Builder i
Address Address
,
N° '7449
TLTION � BUILDING
No. Street _ Part of Lot
Lot . __ Block Addition or Sub -Division .^
Corner Lot — Inside Lot %� Setback __ _ Sideyard
Sewer Elevation -L' :4 6, 0 3 Elevation t ®►�
ToP or Fa4-TlM6
DESCRIPTION OF BUILDING
Tr Used,
�+
Front Depth °� Height Sq. F t. d )Cu. Ft
Front Depth Height Q . Sq. FLI Cu. Ft.
2
Type of 4.truct on � Fit. To be Completed
P RO Pa3-� o 5 rRcer
r� F eF_kT c,a ®P I-� r
In consideration of the issuance to me of a permit to construct the build
the proposed work in accordance with the description above set'% rt ��nd in
ordinances of the city of Fridley.
do
tdw
In consideration of the payment of a fee of $ 1 permit is hereby granted to
Lf
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in eII work
done in, around and upon said building, or any part thereof, ahaII conform in all respects to the ordinances of
Fdley, 1Khin theinances
Building Inspector
NOTICE:
This pandt does not eewr the construction, Indalid lon for wiring, ph nbing, gas boding, Sewer or water. Be sun to as
the Building kqm for for Separate peenih for thea tteam
ns!:"
SUBJECT
City of Fridley
®12181
AT THE TOP OF THE TWINS
BUILDING
P E R M I,
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
812-580-3450
910-F15
6/15/73
JOB ADDRESS 427 Longfellow Street N.E.
1 LEGAL
LOT NO.
BLOCK
TR ACT OR ADDITION
SEE ATTACHED
DESCR.
14,15
7
Spring Brook Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Gordon Schwahe 427 Longfellow Street N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Rile Way Engineering 2654 Lyndale Avenue South
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NPEW ❑ ADDITION ❑ ALTERATION (I REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install Drain Tile in Basement
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
$675 OO
$� 5O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
•
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$60 00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
'j
HEN ROPERLY VALIDATED H!$> YO )R PERMIT
BLDG INSP
7
DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME :1� o s� dy �1 ��� w a BUILDER: Fell I .
ADDRESS : L/ q ADDRESS: o?6,5-Y
NO:. YP 2 STREET:
LOT: BLOCK: ? y/ ADDITION:24,
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
--DEESCpRIPTION OF BUILDING
To Be Used As:
-Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: $6 %s�
To Be Completed: ` /s - °7,3
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct,
DATE: _ �- �-s�- _ SIGNATURE:
(See Reverse Side For Additional Information.)
to
SUBJECT
P
City of Fridley
13553
AT THE TOP OF THE TWINS
BUILDING PERMIT
,
r
REC
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 = �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
6/1/76
JOB ADDRESS 427 Longfellow Street N.E.
1 LEGALLOT
NO. 14 15
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
xg;m
7
Spring Brook Park Addn.
SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP
PHONE
Gordon Schwabe 427 longfellow Street N.E.
3 CONTRACTOR MAILADDRESS ZIP
PHONE LICENSE NO.
Brickner Builders 6245 Ben More Drive, Fridley
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION g] ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Finish Basement
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
$4,000
$2.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. -
STRUCTIO HE PERFORM E OF CONSTRUCTION.
$24.00
PLAN CHECK FEE
TOTALFEE
�- -
$26.00
SIGNATUREOF CONTRACTOR 6Ft AUTHORIZED AGENT (DATE)
WN PROPERLY VALLIIDA,pTEDD THIS IS YOUR PERMIT
h;Z-LICt l—A45—/—!
BLDG. INSP
/ — ,
DATE
SIGNATUREOF OWNER(IF OWNER BUILDER) (DATE)
n
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME:K'cr/ ld��)2 BUILDER: l/✓A' I��''' r (/�G� R
ADDRESS •i-�P, o L, [; l�,/ ADDRESS •
NO • . STREET •,) ),/
LOT: — BLOCK: �� ADDITION:i�11//•'� 07�,gy J� /6&- -
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and propor-..:!d
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
:
Front : Depth: Height:
Square Feet:
Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
i1 �
Type of Construction: Estimated Cost:_ $ 41db
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: /' / SIGNATURE : � yi zJ; /���9�1c
(See Reverse Side For Additional Information.)
Ird 74 �
��, "j
c"iv
7�i� •> `ti"- i i C•' a i :s c? tl l •.P S- L' j.i 4.�'t..''.'�' S.1 `. W... m tr,+l L,..i• i.C.JJ •.�'! d i i t'` G�'. i :
• � b' c
DDpt. of BIdq3. Phona S60.3450
DBSC?IPTIO:t O:' :'IOII._
of F!xh.,.res
Old G� r.ys Cc: pcol
PARTIAL. RATE S HEDU-Ir
r► ^�i• T,,^ T- . _
. ,.U...�J1110 FI:C. J:::. PATES:
NO. PLATF,
TOTAL
T +• � .. �;; 13
i� •^ i
� t �• IIl
7 t l
i
P
>1
F" C.-
3`
i�
<31U�i1i41a$
Catch B.I!in ..................—
ZVa!er Ifeater 'L:p to 9-3.000 BTU) • • • •
x 1;3 C•?
d
1 e a Ground ? u n Old Bldg.........
.: ? .25
5_.----------
..loc•t�.c Ylaa: F'.ost.a2..............
,♦
z °;•�.CO
5
--
NO.
r�{ ``G t a..- —
. A.S (• ♦ i . \Q•
x S2.0
v
Ist 3 Fixtures • • • • ....... • • • " ' •
.75
S
G" P..I=ze toI53.OrA H; J ..........
x S5.G3
S
3rd
i4• ! i
Old G� r.ys Cc: pcol
PARTIAL. RATE S HEDU-Ir
r► ^�i• T,,^ T- . _
. ,.U...�J1110 FI:C. J:::. PATES:
NO. PLATF,
TOTAL
N.:.ber Fixtures ................
—
Fut-.;re Fixture 01,cning ...........
x
:.ew Fixt..re OJct OjPning..........
Catch B.I!in ..................—
ZVa!er Ifeater 'L:p to 9-3.000 BTU) • • • •
x 1;3 C•?
d
1 e a Ground ? u n Old Bldg.........
.: ? .25
5_.----------
..loc•t�.c Ylaa: F'.ost.a2..............
,♦
z °;•�.CO
5
--
NO.
r�{ ``G t a..- —
. A.S (• ♦ i . \Q•
x S2.0
v
Ist 3 Fixtures • • • • ....... • • • " ' •
.75
S
G" P..I=ze toI53.OrA H; J ..........
x S5.G3
S
City of F::dlcy
The undersigned hereby makes apps.1cation for a permit icr the, work her
specified, a,;.ce!nig. to do .;1 wcrk .n !;t-;C#.ac:oz.ddance with 'he C:;T O:�S-a:.
and r:::iag of the 1;cp::rtr.:cnt of Buil "n f, and hereby dec:a-e-, that ZU the f:
and rep:escrt tiers sate: in `:is ap;.:ic.t:o-a am true ar, d
6 7
r id;ey, bIU=
Owner
Kind o: Building
n
Used as
To be completed about
Estirr.at.ed Cost, S ` „g
Old New. F3uildirg Permit lvo• ?e:�:t�40. (�'/_ n
cig td.il
By
Busine�s
ROUGH
FINIAL
L:EaATIOYS--?ofez :a Cuda .5o state Surcharge
........................................
• TOTA:..FT.:.c. S "" .
97 -84-116051
UI I I UI I IIIUI_l_I
APPLICATION FOR PWMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES; N0,
RATE
>,
m
$3,00
Future F "Lura Opening
x
U
New Fixture, Old Opening
x
0
Catch Basin
Via tar
e
water Heater : to 99,000 BTU
4m
iarl'
100,000 BTU to 199,000 BTU
x
$10.00
>dacer Softener
x
A
N
+tp�]
a�
W
x
$5.00
Heater
lst•3 fixtures
x
+W
Additional Fixtures
x
yrrC��
1u
x
u
.
0
.�
0
N
m
qy
'R
a
h
Id►+
rl a
o
C
n
S
.y
L� ISA
ro m
11 N
a m
14
�g
'' IA
iA
�y
u1
U
a
A
•PO
IA•
,3
A 4.
of
W
U W
ri 3
0
O
, as
31st
lit
� 2nd
3rd
4 :h
(R) - Future Connection Opening
Connected with Sewer
(') . New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES; N0,
RATE
Ih=Lber Fixtures
x
$3,00
Future F "Lura Opening
x
$2.00
New Fixture, Old Opening
x
$2.00
Catch Basin
x
X55.00
water Heater : to 99,000 BTU
x
$5100
100,000 BTU to 199,000 BTU
x
$10.00
>dacer Softener
x
$7.00
New Ground Ran Old Building
x
$5.00
Electric water Beater
x
$5.00
GAS FITTING FEES;
lst•3 fixtures
x
$3.00
Additional Fixtures
x
$1.00
c -is Range to 199,000 BTU
x
$1:0,00
REPAIRS $ ALTERATIONS
First $100.00
each add, ;100,00 or fraction
Statq Surcharge
TOTAL FCC
TOTAL,
S
55.00 $
$2,00 $
$ 50
$ 8.00
REIIISPECTION FEL'
ti'
Job Address 427 NE Longfellwo S„reet
Department of Buildings
City of Fridley
Tel. H571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with thu City Codes
and rulings of the Department of Buildings, and hereby declarep that all
tho facL•u and ropruaontaL•ions stated in this application aro t;uo and correct
9-19-79
Fridley, Mn,
OWNER FRICKE
KIND OF BUILDING frame
USED AS Tea. �^
TO BE COMPLETED ABOUT 9-26-'9
ESTIMATED COST 110,00
OLD - NEW BUILDING PERMIT 1d0. PERI4IT 110. <910
Company
Signed By PAIriNE”
Tel, No,
ROUGH INSP.
Data
FINAL INSP,
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR IWY PLUMBING PERMIT IS $7,50 PLUS $,50 ST}Z E SURQIARGE
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacemept)
Gas Range
Gas Dryer °
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
OWNER ,�/2&r /eee� Acs 4
Rate TOTAL
BUILDING USED AS
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
Effective On May 10, 1999
e ?e-zv JV A).E,
ESTIMATED COST c ` PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heatingnits Circll One (Steam) (Hot Water) (Warm Air)
�
$ Trade Name c - A)-6 (6 , -'60 Size No.
BTU Oo HP EDR
$ Fuel A Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
$ The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
jO representations stated in this application are'true and correct.
HEATING CO "kd
*Air Conditioners can not be placed in a side yard without
written permission from adjoining propert owner.
ZCf
?�sse01 o;%). ` 73q
Signed
Approved By
Rough -In Date
DATE
Final Date 116160
TOTAL BTU's
7. Has a liner been provided for water heater Yes ( ) No ( )
S. Has combustion air been provided for water heater Yes ( ) No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHIISMY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes ()
No ( )
2.
Is free from rust or deterioration
Yes ()
No ( )
3. *
Has no foreign objects lodged within
Yes ()
No ( )
4.
Is securely supported
Yes ()
No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes ( ) No ( )
S. Has combustion air been provided for water heater Yes ( ) No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
Effective On January 1, 1997
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
f Water T 11-8—ath i Wash rink. FI Auto, 11 Gas i Gas
Floor I Catch
Staries�
Closet I Urinal Tub -)hoover 'Sink Tray Fount DFain Basin Washer :Appl. Range
Basement!
ME
Aicjc.*-.*� Water Heater
Gas, Elec
-ci tl)e work herein
y codes
a I I thr; ta C",
1 pc
ff113 1 197
HAP- m q tj n/
J.6#" !Dcfu� So 1L)
Final Daot
MIINIMUM FEE FOR ANY -Ut-!5IN.G/GA3 PERMIT IS $20.0
TOTAL FEE PLUS THE $.50 STATE S,, dCHARGE
"COMBU-�TION AIR SHALL BE PROVIDED PER UMC SECTION 504(A)AMD TABLE 6—A. MINIMUM SIZE 9 SO INCHES.
Z�� 3 s
Building BUILDING
$ rf 7.vZ 5
Permit No.: 2�0?,_Oqq
Inspections RESIDENTIAL APPLICATION
Received By:
763-572-3604 CITY OF FRIDLEY
Surcharge
Da dJIUL 2 200
763-502-4977 FAX
$ 5 - 400
SAC Charge
EFFECTIVE 1-1-08
Curb Cut Escrow
$
O
$
Park Fee
DATE S- '
YOUR E-MAIL VPRESS
Sewer Main Charge
$
SITE ADDRESS 1
$
THIS APPLICANT IS: ❑ OWNER O TRACTOR
PROPERTY OWNER/
Nps;
TENANT
ADDRESS: CITY
STATES h ZIPsZ
PHONE: '7 &S— % Ron -- 9 -
NAME:
CONTRACTOR
�/�
ADDRESS:: 4 7 L44& D vol../
Crl'
STATE ZIP d i
SUBMIT A COPY OF
PHONE (01st- -7 8 4 - a 1¢ 44. FAX
YOUR STATE LICENSE
STATE LICENSE # % �7 q
:3
0 EXP
DATE
PROPERTY TYPE
INGLE FAMILY SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
OWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
I,ZrMAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: -
Kn
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT S FT
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES 13 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1.
Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other 13 Fascia
and proposed project.
VVIWWWS
2.
3.
Two sets of construction plans
Energy Calculations
%L tTO�'vl
IN EXISTING OPENINGS JOYYes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING � 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ 3, . CO . OCCUPANCY TYPE
Permit Fee
$ rf 7.vZ 5
Plan Review
$
Fire Surcharge
$
Surcharge
1 -75 -
$ ,75•License
LicenseSurcharge
$ 5 - 400
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
-ft +6 ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and with the ' ota Construction Codes; I understand this is not a permit but only an application fora permit and work is not to start without a
permit on site; th rk wil ' in Icor c with the p an in the cave of all work which requires `�`ew an approva of r /
SIGNATURE OF APP PRINT NAME CJof �'t DATLO' O
APPROVED BY `L &t
JA
\ DAT It