PRE 2010 DOCS4
City of Fridley, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
I 1111J 1 1 1 I► M
Date: ne 15. 1972
owner: Vern Donnay Realty- Inc. Builder Same
Address Avenue North Address
533-2741
LOCATION OF BUILDING
No. --144k__ Street Meadowmoor Drive N.E. Part of Lot
Lot _5_..-___ Block __..__3--__—__ Addition or Sub -Division. MPadowmnor Terrace
Corner Lot _.__.__ _ _ Inside Lot __ X Setback 15- 5 — Sideyard - 10-5
Sbj ff Elevation _.._8.90-67 _ D#o"V0V"WVAh A/ 9 fPet.ahovr_ trahlp Min1murn
Wye Top of Footing (Water Table - 893.2 Approx.)
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front 32' Depth 24.4' Height 20' Sq. Ft. 777.6' Cu. Ft _15.L552
Caxage____ Front 14' Depth 22' Height _1.0' _ Sq. Ft. _ 3.Q$'_ Cu. Ft. 3080'
Type of Construction Wood Frame Est, Cost $19_,580 To be completed 0et.. 1972
SEWER LOCATION: 44' W. of East property line of Lot 5.
WATER KX LOCATION: 31.5' W. of East property line of Lot 5. 12.5' E. of Sewer Service
Stipulations: Permit issued subject to stipulations in "Mutual Agreement" signed by
Vern Donnay Realty, Inc. and dated June 14, 1972.
In consideration of the issuance to me of a permit to construct the building described above I agree tp do
the proposed work in accordance with the description above set forth and in compliance with ;Jl provisions of
ordinances of the city of Fridley. 11_§1 A '. 19
V -
In consideration of the payment of a fee of $ 34. 00 , permit is hereby granted to Vern Donnay Realty
Incorporated 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 all work
done in, around and upon said building, or any part thereof, shall conform in all respects -to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildiM
w. ithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
go
.1
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, Bas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
lot
..y
l F
a� vp k G
1 � S
Applcaflon for Power Pkuft and Heating. Cooiing. Ventilation. Reftpra&n and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
'�_, V rr %-' W A F M AIR:
Furnace Shell & Duct Work
Replacement of Furnace
T?rTair- & Alterations—up to $500.00
w:>na,rs & Alterations each add. $500,M
=3. WARM AIR
Fwrnace Shell & Duct Work to 120,000 BTU
each add. 60,000 BTU ..........
'Replacement of Furnace
f`l rs & Alterations—up to $500.00
:-IFpairs & Alterations each add. $500.00
STEAM or HOT WATER SYSTEM
RATE
°I'A'A%,
. $10.00
$
6.00
$
6.00
$-- —
$
over 199.000 BTU See Fee Schedule
..$10.00
3.W
$
6.00
t-
6.00
$
3.00
$-----
_nftace Shell & Lines—to 400 sq. ft. EDR Steam $10.00
Furnace Shell & Line—to 640 sq. ft.-EDR Hot Water 10.00
Farh add. 200 sq ft. EDR Steam R 00
Each add. 320 sq. ft. EDR Hot Water 3.00
OIL BURNER—to 3 gal. per hour
6.00
$
over 3 gal. per hour—See Fee Schedule
---- __
GAS BURNER (up to 199,000 BTU)
5.00
$
over 199.000 BTU See Fee Schedule
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures
x$ 2.00
$ �� o
Additional Fixtures
x .75
$_
Gas Range to 199,000
x$ 6.00
$
A` CONDITIONING
$
FAII HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
$
A.- _ .LHATIONS & REPAIRS
TOTAL. FEE
$ it
ROUGH
FINAL
Dept. of Bldgs. Phone 560-3450
City of Fridley:
The undersigned hereby makes application for a permit for the work hereir.
specified. agreeing to do as a ork in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the fact:
and representations stated in this application are true and correct. �y,,
Ndiey, NL Unn. _ I. / V
Owner
Kind of Building
Used as – -- ---
To be completed about rrX/
Estimated Cost,
Ol Newuilding Permit No. —
Permit I3o. J s
DESCRIPTION OF WORK
HEATI ti G or POWE:ji 1(I.A1N75--.Steam, Hot Wate arm Ai ;
W� iTrade a\ ame — Size No.
Capacity-- — Sq,Ft. E.D.R. BTU H.P
Total Connected Load_ l Kind of Fuel
BURNER — Trade Name Size No
Capacity — Sq. ft EM.R BTU H.P.
(REMARKS—OYER)
?LTG. & AIR -GOND. W
]l1 niieapolis. Minn. 55416
oma:• :ws ...�.o .. -. .. x;,:.+..� t,.`, ;.ti r
City of Fridley
AppliccMm for Pkv and % RM"
- Dept. of B1dim Phone M -MM
DESCRIPTION OF WORK/ �*4/ /moi E A b
nd
Number, Biand Location of nxtu?" Location
�
PARTIAL RATE SCHEDULE
PLVMBING FIXRATES- NO. RATE TOTAL
Number Fixtures ................ x 8200 $
Future Fixture Opening ........... x $1.50 $ .
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 E
Water treater (Up to 09.000 BTU) . • • • x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Electric Water Beater .............. s $200 $
GAS FITTING FEEM NO. RATE TOTAL
lot 3 Fixtures x $200 i
Additional Fixtures ............... x $ .75 i
Lias Range to 190.000 BTU............ x $5.00
State Surcharge $ .50
REPAIRS A ALTERATIONS—Refer to Cede _
Description 000.o.....m..e s.e...ew..•....•......r•....•�
TOTAL TEE 5 AS
City of Fridley:
The undersigned hereby makes application for a permit for the work herei•
specified, agreeing to do all work in strict accordance with the Qty Ordinancc
and railing of the Department of Buildings. and hereby declares that all the fact'
and representations stated in this application are true and correct
Fridley. Minn? /io_ �/%
Owner
Find of Building
Used as (2
To be completed about /_ d //,5-
Estimated Cost. $'—
Oldew. uilding Permit No. Penait No.
% ,,) "
ROUGH _Q
FII�iA4 G" �'
Signed
Business Phune
Cof Fr'dl 53-84-S-915.51
rtY ®y
Appaafioe for Phmbbg and Crm R hnak
Dept. of Bldtla. Phone 5604490
DESCRIPTION OF WORK
Number, Kind and Location of Fixtured
PARTIAL RATE SCHEDULE
PLUMSING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ x $200 $
Future Fixture Opening ........... x $1.50 $--
New
-New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater :Up to 99,000 BTU) .... x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Electric Water heater ............. x $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .................. x $2.00 $
Additional Fixtures .................. x $ .75 $
Gas Range to 199.000 BTU.. . 1 x $S.00 $ 5.00
REPAIRS A ALTERATIONS—Rotor to Code
Locate 11" N. E. Meadow Moore Drive
City of Fridley:
The undersigned hereby makes application for a permit for the' work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the tact
and representations stated in this application are true and correct
Fridley, Minn 11-6-72 „ 19,
Owner Vern Donna' Homes Inc.
Kind of Building Frame
Used as Res.
To be completed about 11-13-72
Estimated Cost, $ 10.00
drew. Building Permit No. Permit No. (: g 3
Sign (d
gy haiNNEGASCO --._
Business Phune No
ROUGH
FINAL
Description ..........................................,.. $
TOTAL FEES 5•�� 91A ;�-y�Toharge $.50
(SURCHARGE $_.50)
3
Yi<y
;if
}tz��
�iC
�ggcc
y
32
Q5
<
vjy�
(�7d
C�9
•
I
•
N
WATER NTR.
GAi
ELEC.
Base
1st
1
2nd
3rd
4th
-Future Connection Openings
+ Now Fixture. Old Openings
Connected with
Sower ❑
C"BPoo1 ❑
PARTIAL RATE SCHEDULE
PLUMSING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ x $200 $
Future Fixture Opening ........... x $1.50 $--
New
-New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater :Up to 99,000 BTU) .... x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Electric Water heater ............. x $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .................. x $2.00 $
Additional Fixtures .................. x $ .75 $
Gas Range to 199.000 BTU.. . 1 x $S.00 $ 5.00
REPAIRS A ALTERATIONS—Rotor to Code
Locate 11" N. E. Meadow Moore Drive
City of Fridley:
The undersigned hereby makes application for a permit for the' work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the tact
and representations stated in this application are true and correct
Fridley, Minn 11-6-72 „ 19,
Owner Vern Donna' Homes Inc.
Kind of Building Frame
Used as Res.
To be completed about 11-13-72
Estimated Cost, $ 10.00
drew. Building Permit No. Permit No. (: g 3
Sign (d
gy haiNNEGASCO --._
Business Phune No
ROUGH
FINAL
Description ..........................................,.. $
TOTAL FEES 5•�� 91A ;�-y�Toharge $.50
(SURCHARGE $_.50)
SUBJECT
PE O.
City of Fridley
19171
AT THE TOP OF THE TWINS
BUILDING
PERMIT
_
r
�
R
• COMMUNITY DEVELOPMENT DIV.
LV _____
� INSPECTION SEC.
9
r � PROTECTIVE
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
,J
612-571-3450
910-F15
9/15/87
JOB ADDRESS 1444 Meadowmoor Drive N. E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
3
1 Meadowmoor Terrace
SHEET
2 PROPERTY OWNER MAILADDRES$
ZIP PHONE
Chan Duong 1444 Meadowmoor Drive N.E.
780-1787
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Patio Enclosures 6219 Cambridge Street
920-1575
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 ❑l ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 4' x 3' Deck and a 15' x 10' Porch.
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan
M
W ARKI816
Before digging caA local utilities
SEPARATE PERMITS REQUIRED FOR
TELEPHONE-ELECTRIC-GPS Ett-
,�,►�,� i-►"' I'tiG,' 1����DING ARID SIGNS.
REQUIRED BY LAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. 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
ISTALLS 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,200
$1.60
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-
TR CTION OR THE PERFORMANCE OF CONSTRUCTION.
$44.50
9
kAN CHECK FEE
TOTALFEE
$11.13
$57.23
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
" HEN PROPERLY
LIDATED THIS IS YOUR 9ERMIT,
BLDG INSP
%
- qAT
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE)
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [)o] �R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Addre
Legal Description:
Owner Name & Address: G�'G,� ®` eiei ��d"y Tel. 7W -1 7kF7
Contractor • _roseS Tel. #
Address: 6� �� G4H• fie,% e S: -
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA:
Length
Width
Tel.
GARAGE AREA:
Length
Width
DECK AREA:
OTHER:
Corner Lot [ ]
Length_ Width
�d �GLi V t 15b 20 -
Inside Lot [x] Ft. Yd. Setback _
Type of Construction: Z-O'Ooof e- �'���"
Approx. Completion Date: ��3•�-��
Proposed Driveway Width If New Opening Is Desired:
Height Sq. Ft.
Height
Hgt/Ground
U z'3.i2a"
Sq. Ft.
Sq. Ft:
of •�
�f Side Yard Setback
Estimated Cost: $ 41 a 3 � v
Alt. A Alt B
See Back Page for Explanation
DATE: la -,f7
APPLICANT:
J
Tel.
-CITY
USE ONLY
Permit Fee
$ U q .
Fee Schedule on Reverse
Side.
Plan Check
$.13 25% of Bui}dg/Permit
Fee
State Surcharge
$ J • O
$.506'1,? 0 Valuation
SAC Charge
$
(,,'4$/525 per SAC Unit
Park Fee
$ X,S�
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [
] Not Necessary [ ]
TOTAL
$ •
STIPULATIONS:
G�.�.�
2X 6
4®
NEW I ] City of Fridley Effective 5/1/88
ADDN I R-1 AMID R-2
ALTER [ ] Building Permit Application
Omstruction Address:_ / 'V IV`s 11jeadowlyear AT'
Legal Description: oafs c/a- c A 3 /ei rr i.e �P-
Owner Name & Address: Ch" "4 «y�( Mead's mane- Dr Tel.
® r
Onntractor: Se'l� Tlel. #
Address: _iVqzl ,�iP& �� ®'►►�� w^ fir.
Attach to this application, a Certificate of Survey of the
lot, with the proposoed mnstruction drawn on it to scale.
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height 13 Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
ODrner Lot [ ] Inside Lot I ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Vy 00 - Yra me, Estimated Cost: $ 17?/.
°=
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired:
Width + 6'
DATE: eto APPLIam:
CITY USE COLY
Peanit Flee
State Surcharge
SAC Charge
Driveway Escrow
Park Flee
Sewer !lain Charge
TOTAL
SZ'IPO MIONS:
5
Alt. A Alt. B
See Back Page
Flee Schedule on Reverse Side
$.50/51,000 Valuation
$550 per SAC Unit
Alt. 'A" or Alt. 'B" Above
Fee Determined by Engineering
Agreement Necessary I ] Not Necessary [ 7
I UfL
i
SUBJECT
P O
City of Fridley
19 6 3,7
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
RECEIPT NO.
►y__ COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
�
734
1 I
`
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-Fl S
8/18/88
JOB ADDRESS 1444 Meadowmoor Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
3
Meadowmoor Terrace SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Chen Young 1444 Meadowmoor Drive N.E. 780--1787
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW Ek ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 12' x 22'.Garage Addition
9 CHANGE OF USE FROM TO
STIPULATIONS provide a hard surface driveway. See notations on plan.
Footings must go below the layer of black peat (possibly 12".to 24")
before pouring.
WARNING SEPARATE PERMITS REQUIRED
FOR
WINK. HEATING,
Before digging call local utilities PLUMBING AND SIGNS.
TELEPHONE - ELECTRIC - GAS Etc.
REQUIRED BY LAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
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
ISTALLS 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
$3. 79.1
$1.90
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
ANY OTHER STATE LOCAL LAW EGULATING
PROVISIONS CON-
$63.00
STRUCTION ORFTHE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$64.90
ISIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY V (DATED THIS IS YOUR PERMIT
114
BLDG (NSP QZ TE
$iGNATURE OF OW ER tIF OWN BUILDER( I ATE(
i
Building
$
BUILDING
See Back Page for Fee Schedule
Permit No.0CQ'%-G0y%7
Inspections
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572=3604
.001 times the total job valuation
CITY OF FRIDLEY
$_
Date P: 0
DATE ' ?C
YOUR E-MAIL ADDRESS
$
SITE ADDRESS / �XLqC4Z-AC✓
.c. Ff r -j (1..4 All /X-)
SAC Charge
THIS APPLICANT IS:
0 OWNER ❑CONTRACTOR
$1675 per SAC Unit (Plans to MWCC for determination)
PROPERTY OWNER/
NAME:
TENANT
ADDRESS: 1Yq6J �✓�if c, c wn? ti Jn- CITY I C
STATE/-I iIP s-—Y?2
PHONE:?
Park Fee
CONTRACTOR
NAME:
Fee Determined by Engineering
STATE LICENSE # EXP DATE
$
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH❑GOOF ❑ DRAIN TILE
❑ DECK ,,P� SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ,REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. FL
ROOFING NG
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
Vinyl
fflt
ADDITIONS. & PORCHES SUBMIT:
E3Aluminum
rim
tF
I.
Site Plan/Survey showing the existing structures
❑ Other
scia
and proposed project =
WINDOWS
2.
3.
Two sets of construction plans
Energy Calculations
IN EXISTING OPENINGS Yes
❑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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ -2, aw . --J OCCUPANCY TYPE
Permit Fee
$
cl'.25
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
-130
.001 times the total job valuation
Surcharge
$_
/ . (%L%
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft.+ 6 ft= ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
`'�i �_ .
Make checks payable to: City of Fridley_ Attach Stipulations .
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 Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which rree moires review, and approval of plans.
SIGNATURE OF APPLICANT" G `�4 ' ,-' C` �' G ` j PRINT NAME / 1 I .G' C Cr+ e , DATE - J