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PRE 2010 DOCSDate: JUNE 5, 1967 Address City of Fridley, Minn. BUILDING PERMIT Builder ,P®6,? N9 928'7 HOMEDALE BUILDERS Address 5217 WAYZATA BOULEVARD MINNEAPOLIS, MINNESOTA LOCATION OF BUILDING No. 7457_ Street _.._ MELODY DRIVE N. E. Part of Lot Lot — 9 �_ Block 5 Addition or Sub -Division .MELODY MANOR, 4TH ADDITION Corner Lot ---- Inside Lot — X Setback — 35 ' __ Sideyard —_ 10 and 5 880.48 Elevation 883.48 Sewer Elevation �� ._._ TOP OF FOOTING DESCRIPTION OF BUILDING To be Used as: DWELLING Front ___.46 Depth 24/28 Height 20 Sq. F•t. 1,152 Ca. Ft. 23,040 GARAGE Front 20 Depth 24 Height 10 Sq. Ft. —A8 0 Cu. Ft. _ 4.8 0 Type of Construction __ FRAME Est. Cost _ $18,500.00 _ To be Completed SEWER LOCATION - 29 23' West of Manhole WATER LOCATION - 10' East of Sewer In consideration of the issuance to me of a permit to construct the building d above I agree to do the proposed work in accordance with the description above set, forth and in con ce with a�l provisions ordinanoEs of the city of Fridley. $lOO.0 NSSSD SEWER CHARGE 1' In consideration of the payment of a fee of $ 28.00 , permit is hereby granted to HOMEDALE BUILDERS 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 buil�ng� within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. CLARENCE BELISLE Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be etre to we the Building Inspector for separate permits for than hone. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY,.MiNNESOTA OWNER'S NAME BUXLDFAit ADDRESS ADDRESS g LOCATION OF BUILDING NO, /��� STREET - PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION, ® i CORNER LOT INSIDE LOT SETBACK SIDE- IA9 SEWER ELEVATION 7 d ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. M 4tRI ON OF BUILDING G° To be used as; Front _Depth Height Sq. Ft. //s Cu. Ft. -3 �® Front Depth._,g tl Sq. Ft.. Cu. Ft. �A _(775 . Type of Construction_ '1�025e Estimated Coat_ 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`i �� SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side).AO �y/�% Date: Owner: Address City of Fridley, Minn. BUILDING PERMIT OCTOBER 6, 1967 HOMEDALE BUILDERS 5217 Wayzata Boulevard Minneapolis, Minnesota No. 7457 Lot -___ 9 Corner Lot Sewer Elevation Builder Address N9 949. 4? �-j �' / * , ' A.B.C. BLACKTOP COMPANY 1308 Main Street N. E. Minneapolis, Minnesota LOCATION OF BUILDING Street —. MELODY DRIVE N.E. _ __ Part of Lot Block 5 Addition or Sub -Division . MELODY MANOR, 4TH ADDITION Inside Lot --- Setback --_ Sideyard �— — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: ASPHALT DRIVE Front Depth Height _ Sq. Ft. CtL Ft. Front Depth Height _ _ Sq. Ft. T Cu. Ft. Type of Construction ASPHALT Est Cost —_$148. _ To be Completed _ In consideration of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above adt forth in compliance with adl provisions of ordinances of the city of Fridley. �— i In consideration of the payment of a fee of $ 5.0 , permit is hereby granted to A.B.C. BLACKTOP COMPANY 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 buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. CLARENCE BELISLE Building Inspector NOTICE: This permit doer not cover the construction, instillation for wiring, plumbing, gas heating, sewer or water. Be sure to am the Building Inspector for separate pemiih for these hems. e Pt''�:�C:#t1G'a +tC.t fi)JII,DIiiG n221_MtT CITY 0:7 ny-mi'a-, Pi iNNES CTA OWNER'S NAME ADDRESS ADDRESS LOCATION Or BUILUIING NO. `� ' S STREET_P �'� e L/ �PART OF LOT ell LOT BLOCK ADDITION OR SUB IXISION Aa' CORNER LOT INSIDE LOT SETBACK. SIDE -YARD SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used Ad; DESCRIPTION OF BUILDING - Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height _Sq. Ft. Cu. Ft. Type of Construction1Q fj� Estimated Cost/ 70� To Be Completed f "fir :7 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 G'. (Schedule of Fee Costs can be found on the Reverse Side}. M C I T Y O F F R I D L E Y 6431 University Ave. N. E. Fridley, Minnesota 55421 Spencer Electric 3017 Lyndale Ave. S. Minneapolis, Minnesota August 5, 1968 RE: PP IT SHORTAGE 7457 Meldey-Brive Melody Drive Gentlemen: Your permit for the above captioned address was short the following: R W $3.00 Dryer 3.00 $6.00 We would appreciate it if you would kindly give this matter your preferred attention. When sending in the above amount, kindly place it on a regular Minnesota State Affidavit so that we may properly process this permit. Thank you. LE :bks Yours very truly, LEONARD EICHMILLER Electrical Inspector City of Fridley SUBJECT R City of Fridley 1-20936 AT THE TOP OF THE TWINS BUILDING PERMIT- RECEIPT N DEVELOPMENT DIV. _ "" -77COMMUNITY � �j' r ; PROTECTIVE INSPECTION SEC. '1 { /--'1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 7/12/91 JOB ADDRESS 7457 Melody Drive NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 5 Melody Manor 4th_ Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Breitenbach 7457 Melody Drive NE 786-5321 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. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION p REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (27 Squares) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Roofing must meet State Building Code for ice and water shield. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,144 $ .57 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $29.00 Fire SC $1.14 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $.30.71 SIG ATUREOFCONTRACTOR ORAUTHORIZED AGENT IDAATEI " d HEN, RO/PpEO'p/iLY LIDATED THIS IS YOURPERMIT / /00 IR DG INSP nA TE iGNATURE• •WNER IIFO NER BUILDE IDAT I NEW [ ] Effective 1/1/91 ADrN [ ] R-1 AMID R-2 ALTER [ ] Building Permit Application �* 0: f--joh t ,y --o n -- Owner Nam & Address: _ o / Dery ' 1)r i rpl41- /n 11%,i"""2 xlx-;,�A Tei. # ?09'5-30J contractor: W. # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. =VM AREA: Length Width Height Sq. Ft. QRRAGE AM: Length Width Height Sq. Ft. U= AREA: Width Hgt/Cround Sq. Ft. Corner lot [ ] Inside Lot rj Type of Construction: Approx. Om pletion Date: Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ // X14 Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Wi + 6' See Back Page DATE: - APPZSCANr: CITY usE QriLY Permit Fee $ C)6 Fire Surcharge State Surcharge $ S7 SAC charge $ Driveway Escrow $ Park Fee $ Sewer Main charge $ $ 3C - 7 / STIP MATICKS : t Fee Schedule on Reverse Side .001 x Permit Valuation (1/10th $) $.50/$1,000 Valuation $650 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Emji raer *±g Agreement Necessary [ ] Not Necessary [ ] Building t "' Inspections 763-572-3604 DATE__ SITE ADDRESS _ THIS APPLICANT IS: OWNER/ TENANT SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: -V® AMCHANICAL RESIDENTIAL APPLICATION .CITY OF FRIDLEY E-MAIL ADDRESS Permit Received By Date Rec'd: ?1 1 , Q ADDRESS' CITY STATE ZIP PHONE: '7l n�i �i�-552' COMPANY CONTACT PERSONirS-PG1Y"" 11"wa® ran raysu�, STATELICENSEO 2619 COON RAPIDS BWdi 5VARD ADDREss: COON RAPIDS. MN 55433 CITY S FAMILY OTWO FAMILY ❑'TOWNHOUSE O NEW PLACEMENT 0 ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (Tits should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS S . FEES ARE BASED ON S10.00 PER FDn IM134 EXCEPT WHERE NOTED. FDCTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) SMMTU � DDD Equipment InswIled MFG: O MODEL MFG: MODEL: SIZE m MFG: MODEL: _ SIZE/BTU FIREPLACE(GAS)315.00 GAS RANGEIOVEN $10.00 _LAIC $25.00NEW GAS GRILL $10.00 AIR TO AIR EXCHANGEER S15 FIREPLACE (WOOD) $35.00 GAS UNIT HTR $10.00 BOILER 535.00 TFURNACE $35.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 1'�L HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 4VENTILATOR $15.00 Permit Fee $ •®® Number of fixtures @ $10-00 x $10.00 = Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ to (D.. Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $SQ Total = $ 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 of the City of Fridley and with the Minnesota -Construction Codes; that I understand this is not a permit but only an applicatio fora permit an w rk is not to 'thout a permit; that the work will be in accordance with the approved plan in the of all w rk 'ch requbew and ap roval plan- A I SIGNATURE OF APPLICANT City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, NIN 55432 '74'A_9'7')_zAna Business Name City Bond Expiration Deer River Plumbing & Heating, Inc. Deer River 9432976 6/30/2006 Deforge's Plumbing, Inc. St. Louis Park 9864486 5/31/2007 DeJager Plumbing & Heating, Inc. Brandon 2497236 11/18/2006 Deml Heating, Air Conditioning & Fireplace Connections, Owatonna 69569101 8/11/2006 LLC Denio Appliances Center City RLI 555745 4/25/2007 Den -Mark Plumbing, Inc. Maple Grove 70005135 12/31/2006 Dennis C. Clauson dba Peter Plumbing Co. Roseville 70044120 2/5/2007 Dennis Dwight dba Dwight Corporation Walker 14703514 5/11/2007 Dennis E. Le Vasseur dba La Vesseur Plumbing & Maplewood 70094506 5/1/2007 Heating Dennis Hansen dba Hansen Mechanical Cold Spring 69677778 3/11/2007 Dennis Hass Repair Frazee 047706 1/6/2007 66281527 Dennis Meeks dba The Utter End Heating New York Mills 93GN74128 12/3/2006 Dependable Indoor Quality Air, Inc. Coon Rapids RLI 561433 8/22/2006 Derson Manufacturing, Inc. Watertown 69591524 9/25/2006 Design Irrigation, Inc. La Crosse 14723210 7/6/2008 DeZIeI Heating & Air Conditioning Buffalo 0481420 8/13/2006 Diamond Mechanical, Inc. Lindstrom 69856211 2/8/2007 Dicdon, Inc. dba Heating Concepts Maplewood 9319861 10/19/2006 Dick's Plumbing & Heating of Bemidji, Inc. Bemidji 9319825 10/6/2006 Diers Plumbing & Heating, Inc. Howard Lake 9432976 6/30/2006 Dietel Plumbing & Heating, Inc. Lester Prairie 9319995 11/12/2006 Dimension Plumbing & Heating, Inc. Rochester 5634169 11/23/2006 Dinius Plumbing Co. Oakdale 14648590 2/24/2007 Direct Digital Controls dba Prairie Technologies, Inc. of Otsego RLI 0589401 1/23/2007 MN Discount Appliance, Inc. Blaine MN24427 5/12/2007 Differ, Inc. Hamel 69574650 8/20/2006 Ditty Plumbing, Heating & Air Conditioning Delano 9432976 6/30/2006 Diversified Electric, Inc. Brooklyn Park 9864495 6/13/2007 Diversified Refrigeration, Inc. Buffalo 66185938 9/8/2006 DJ's Heating & Air Conditioning, Inc. Albertville 9432976 6/30/2006 Thursday, June 15, 2006 Page 15 of 57 Building $ BUILDING Plan Review Permit NO.: Inspections Fire Surcharge RESIDENTIAL APPLICATION Received By: 763-572-3604 License Surcharge $ Date'.: J U N 18 200 SAC Charge $ CITY OF FRIDLEY Curb Cut Escrow $ DATE —�' 6� YOUR E-MAIL ADDRESS o—o-e , �tJn^ Qcq S f -,1t-Q SITE ADDREss —7'15--7 yy\e io Lt OrLi-e . $ THIS APPLICANT IS: ❑ OWNER %CONTRACTOR $ PROPERTY OWNER/ NAME: C���•i�z+-!'ev`64os $ ADDRESS: "l `1 1 kvUt logy CITY Fr; J STATE•'t'1 A&IP_T TENANT PHONE. 7 - 7 (o Z 1 CONTRACTOR NAME: STATE LICENSE # QQS-/ of 0I �a EXP DATE g SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: �r `I I V z CITY IQ�d� , h STATIJ!1411` WITH APPLICATION PHONE2- oZ �" S `i 4., 9 FAX 95 /— 3 / "7 PROPERTY TYPE JZSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED WS ❑ BASEMENT FINISH [3 ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR REMODELING DESCRIBE WORK BEING DONE: c .� lac e l�� h �o� �S PiR�O 0c:;kD r SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ 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: SIDING FOR NEW CONSTRUCTION INCLUDING DFyCKS. ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project R'INDOR'S 2. Two sets of construction plans IN EXISTING OPENINGS *es ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WNDOWS 42W-'t ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USINC TUV 100'7 1T.B.0 FEE SCHEDULE) TOTAL JOB VALUATION OCCUPANCY TYPE Permit Fee $ 7 Plan Review $ Fire Surcharge $ Surcharge $: License Surcharge $ SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ 5 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) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= 8x$21=$ $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 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 requires re w and a proval of plans. / SIGNATURE OF APPLIC,4T PRINT NAME L�rJ � DATE �o �v cs-1 Building ' $ BUILDING $ Permit No.:f1 Inspections Surcharge RESIDENTIAL APPLICATION Received By: 763-572-3604 Total Due CITY OF FRIDLEY DateMMMAY I g 763-502-4977 FAX EFFECTIVE 1-1-09 DATE 51 a YOUR E-MAIL ADDRESS r� u- mCC31 r SITE ADDRESS -7 IV) elbdLk Y - THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: r el— TENANT ADDRESS: CITY 1 G STATFJnZIP PHONE:_ �% '- 7 66 v -S CONTRACTOR NAME: V -- e r 0 t C, f 5 SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # o� 0-5- e� EXP DATE 3 AND CERTIFICATE OF ADDRESS: �� ��( Q CITY ISTAT ZIP INSURANCE PHONE % o� — FAX "7 5 — D PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYMEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH QOF ❑ DRAIN TILE ❑ DECK ❑ 91DING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: If`.ej7�Gi�� F'C1D SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT so FT ROOFING 16 HOUSE ONLY NUMBER OF SQUARES ❑ 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 I . Site Plan/Survey showing the existing structures ❑ Other ❑Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. 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: (USINTOTAL JOB VALUATION $ r) alD 9 97 U.B.0 FEE SCHEDULE)OCCUPANCY TYPE Permit Fee ' $ Plan Review $ Fire Surcharge $ Surcharge $ 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) $2000 per SAC Unit (Plans to MWCC for determination) -ft +6 ft= ftx$22=$ $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 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 on site; that the work will be in accordance with the approved plan in the case of al work whic equires review and approval of plans. 1 ,� // r� / SIGNATURE OF APPLICAN PRINT NAME L"OW 040 L/ DATE /�/��%_