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PRE 2010 DOCSDate: City of Fridley, Mian.. BUILDING PERMIT Feb. 5, 1968 Homedale Blders Builder Address 5217 Wayzata Blvd. Address Same Same -4�0"f9 Na 9608 LOCATION OF BUILDING No. 7472Street _ Melody Drive _ ____ part of Lot Lot _30 --- Block 4 .— Addition or Sub -Division ___.._ Melody Manor 4th Addn. Corner Lot .__ Inside Lot ._._.X–. Setback — 3'--_ Sideyard ._._10'_ Sewer Elevation Foundation • Elevation DESCRIPTION OF BUILDING To be Used as: Dwelling Fent 32 Depth 24' Height 28' Sq. Ft. 768 Cu, p�t 21,504 Garage ___ Front 201 Depth 22 ' Height ._._..10' Sq pt R 440 Cu. IM 4400 Type of Construction Frame Est. Cost __.. $20, 000 __ 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 set forth and compliance with provisionsof ordinances of the city of Fridley. le 1117 $100.00 Sewer Connection Charge In consideration of the payment of a fee of $ 39.00 , permit is hereby granted to Homedale Blders . 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 tofe ordinances of Fridley, Minnesota regarding location, construction, alteratio main ce, re and mg ofswithin the city limits and this permit may be revoked at any t�me upon f aa* of thovisions of said ordinances. l I 71 Official NOTICE: This perm(t does not cover the coadmcdoe, installation for wiring, plunhin8, Bas heattns, sewer or water. Be sure to we the Buildh* Inspector for separate permits for these items. Cl -%7Y 913 NYMSESOTA 01MER' S NAME F,z: 't •TiEi'. . _ ...__., . , • _. Y ADDRESS .� .� �...�� >.���... � � _.�.�..� ADD.:i:SS�-�- �5 9,0 - LOCATION OF BUILD!ZIG NO.- STREET .� ._��� .w.. > PART OF LOT LOT BLOCth� ADDI, UN OR SURD" VISIUi��` CORNER LOT INSIDE LOT J --SETBACK �15_ _.SIDE­y SEWER ELEVATION FOUNDATION ELEVIYZION Applicant attach to this form Two Certificates of 'Survey of Lot and proposed bui?.din- location draxm on these Certificates. DESCRIPTION OF BUILDING To Be Used As r Front_�__r Depth FIeight '*_,g �. Sq. Ft. — Yw: Cu. Ft. Front Depth �7_ 7�_ —Hei ht % Sq. Ft.- Cu. Ft._ Type of Constructionr�ca e Estimated Cost To Be Completed � -;— r 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 - - _ SlGiiltkTU� (Schedule of Fee Costs can be found on the Reverse Side) l� I� �-r A ¢cc, "roo T�1 X13 � N1 Application for Power Plants and Healing. Cooling. Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3450 GRAVITY WARM AIR: RATE TOTAL Location Furnace Shell & Duct Work ..........................$10.00 6.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR NO RATE TOTAL 1st 3 Fixtures ..... ................ Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ 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 $ Additional Fixtures ................ x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE $ ri ROUGH FINAL City of Fridley: The undersigned hereby makes application for a permit for the work hereir. 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 facts and representations stated in this application are true and correct. Fridley, Minn_'`: e 19 Owner Kind of Building Used as ,t To be completed about ���✓ J 1 < - Estimated Cost, $ Old." Building Permit No. — Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS -Steam, Hot Water�Warm Air`—No� Trade Name '��i� `w ��Size No �'�✓>'' va m Capacity Sq. Ft. E.D.R., BTU H.P. a• Total Connected Load �' =o, �/ -' Kind of Fuel BURNER —Trade Name z ' ! Size No- Capacity Sq. Ft. E.D.R BTU H.P. (REMARK VERj RAY N. WELTER HEATING CO. Signed_ 463 7 CH I CA G - - • - B�dINNEAPOLIS 7, MINNE80TA as Business Phone No- r L` apo A City of Fridley 031�1 ' Application for Plumbing and Gas Ming Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures �I RATE TOTAL Number Fixtures ....... ...... ....... x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ...... ..................... x $3.25 $ Water Heater (Up to 99,000 BTU) ...... F N WATER HTR. GAS ELEC. +� 3 7 GAS FITTING FEES: NO. RATE n� x $2.00 o� Additional Fixtures .................... O� t� <3 �•! (�90� �p Base 1st 2nd 3rd 4th • Future Connection Openiags Connected with New Fixture. Old Openings I Sewer Cesspool 0 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: RATE TOTAL Number Fixtures ....... ...... ....... x $2.00 $ Future Fixture Opening ................ x $1.50 $ 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 z $2.00 $ GAS FITTING FEES: NO. RATE 1st 3 Fixtures .......................... x $2.00 �TOTAALL $_ �.=_ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ /'• TOTAL FEE $� 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 fact and representations stated in this application are true and correct. Fridley, Owner Kind of B ing Used as To be completed about Estimated Cost, $---,, Old—New. Building Permit ROUGH FINAL Phone No — & City of Fridley SUBJECT P , ®1411 AT THE TOP OF THE TWINS BUILDING PERMIT CEIPT NO. % ______ COMMUNITY DEVELOPMENT DIV. r i PROTECTIVE INSPECTION SEC. 1 . � CITY HALL FRIDLEY 55432 IL If ,•J NUMBER REV. DATE PAGE OF APPROVED BY L"" 612-580-3450 910-F15 5/31/77 JOB ADDRESS 7472 Melody Drive N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 30 4 Melody Manor 4th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bruce R. NXV Danielson 7472 Melody Drive N.E. 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 Q ❑ NEW R ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 1516" x 13' 3 season porch off back of dwelling 9 CHANGEQFUSEFROM TO STIPULATIONS Area cannot be heated unless the porch.were altered to meet Energy Code. SEPERATE PERMITS REQUIRED FGR WIRING; NlRI'1�+ I�Vi�ING AND SIG�t�& '%kie dlRtina caN iii ubft TELEPHONE -ELECTRIC • Cm Etc REQUIRED BY LA 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND GOVERNINGTYPE OF WORK WILL BE ORDINANCES $5,500 $2.75 WITH WHETHER SPECIFIED HER INIOR NOT. THE GRANTING OF AOPERMIOT 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- $33.00 STRUCTION OR THE PERF RMANCE OF CONSTRUCTION. ( PLAN CHECK FEE TOTAL FEE lair K� a.-� $35.75 GNATUREOFCO RACTOR'ORAUTHORIZEDAGENT (DATE) J WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT i� 6--.31M �l �A �1_� �) 1- NATUREOFOWNER UFOWNER BUILDERI IDATEI `� • BLDG iNSP DATE a CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS, (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: ' &�BUILDER: �C Address: �� ��� 1()AA E Address:. Tel. No.: W ' No.Street :A2t7iQ LOT: BLOCK: _ ADDITION: /%G 7 A111 V ©4 - */5 CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Sc'ti}3 0 � Jobb--. Front: r 6 d Depth: /.3 � Height: Square Feet: Front: Square Feet: Cubic Feet: Depth: • Height: Cubic Feet: /O f Type of Construction: 6.0662 `, Estimated Cost: $ -,,'Sb O To Be Completed: -9 "ey-, leiA Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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. See reverse side for additonal formation. DATE: `j '3 ►' .77 SIGNATURE •2�14 ' Stipulations: Q►( "�.Q 006'r L ca (to 02,9,j Ajor Be 11, -110 a f SUBJECT22043/, 'RIVTIT NO. City of Fridley AT THE TOP OF THE TWINS ? BUILDING PERMIT r . COMMUNITY DEVELOPMENT DIV. -RECEW_TA0-.-_ tr _ r PROTECTIVE INSPECTION SEC. _ , CITY HALL FRIDLEY 55432 NUMBER REV GATE PAGE OF APPROVED BY �J 612-571-3450 910-F15 8/19/93 JOB ADDRESS 7472 Melody Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 30 4 Melody Manor 4th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bruce/Kay Danielson 7472 Melody Drive NE 786-5145 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. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION (� REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (23 Squares) 2nd Layer 9 CHANGEOFUSEFROM TO STIPULATIONS Roofing can be 2nd layer but not 3rd, Install adequate ventilation. Provide smoke detectors as per URC 1210 adjacent to all sleeping areas and in basement. 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 SQ. 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 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 $� �0Q $" 95 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT F 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- $43•.00 Fire SC $1.9.0 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $45,85 iG ATURE OFCONTRACTOR O NORIZEDAGENT IDATEo WHEN THIS IS YOUR PERMfi YLY,,�L4DATED BLD S ")ST E f SIGN f RE OF OWNE i F OWNER BULLOERi [DATE) - NEW [) Effective 5/26/93 ADDN [ J CITY OF FRIDLEY� ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application n 6� Constructxo Address. Legal Description: —4;L/ � L , �. _ `� e A7 LU J L- j ✓ 7rJ -" s� •r- aner �. 1 1 1 1 1 ♦ .REM! ._� Address: Attach 1this application,a Certificateof Surveyof 1 lot, with theproposed ♦f +1 4 1 1 drawn on to fH DESCRIPTION OF DRPROVEMENT LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length n 9 T Width Height I Sq. Ft. Width Height Sq. Ft. Widthy Hgt/Grouad Sq. Ft. '1-' Corner Lot [ J Inside Lot [ J Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: Driveway Curb Cut Width Needed: (Cost on Back) Ft. + 6 Ft = Ft x $ _ $ DATE: -3 APPLICANT: Tel. #� 5�%s CITY USE ONLY TOTAL STIPULATIONS: Permit Fee $ J-/ J-1 Fee Schedule on Reverse Side Fire Surcharge $ f' .001 of Permit Valuation (1/10th%) State Surcharge $ , qS— $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ Conservation Plan Review $450.00 Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ) Not Necessary [ ) TOTAL STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1905 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTtMS AND DEVICES JOB ADDRESS Z RATE SCHEDULE' 4 The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings. of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ 30 ' representations stated in this application ar true and correct. (Side Vent — Fill Out Back) .3 0 ,1995 Gas Piping (Needed with new furnace) $10.00 $ OWNER Gas Range $10.00 $ ' BUILDING USED AS Gas Dryer $10.00 $ ESTIMATED COS PERMIT PERMIT NO.>� *Air Conditioning — All Sizes , $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) I% of Value of Appliance or Work $ No. of Heating Unit Circle One (Steam) (Hot Water) arm Air) Trade-NameSize NoGaot?4—/ 6-6 Commercial/Industrial BTU6,5- 6VV HP EDR 1.25% of Value of Appliance or Work $_^ Fuel Total Connected Load State Surcharge x.50 Burner.Trade Name Size No. -FEE BTU HP EDR TOTAL HEATING COMPANY l�- MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed BTel No. :o,S�d= PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved B ough—in Date '�-g�Final Date *Air Conditioners can not be placed in a side yard.without FILL OUT BACK SIDE FOR STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes -0 ) 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 o No ( ) 6 Has total heating BTU's of , f P --b All other BTU's' S J TOTAL BTU's 7. Has a liner been provided for water heater Yes () N ) 8. Has combustion air been provided for water heater Ye�s) No ( ) a List ALTERATIONS Bd= Done: 4. r • r HEATING CO:- P � ♦A Signed By:— Date: '> 7 U G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 November 9, 2001 Bruce Danielson 7472 Melody Drive Fridley, MN 55432 Re: Final Inspection at 7472 Melody Drive Contractor: Norblom Plumbing Co. Dear Mr. Danielson: A plumbing permit was issued on November 20, 2000, to install a water heater at your address. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspections to make sure the work was completed according to the Plumbing Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will expire the permit and no further action will be taken. To set up the inspection, or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh ri�fff OF FRIDLEY INSPECTION DIV. ley, '- University Ave NE MN 55432 572-3604 Effective On May 10, 1999 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Stones ....-.--:-:. Urinal F3 '. Shower .%.Tray...... 3 ....:.:..Drain Floor rWa$h ""Auto. --Wash . 0 er �`_.:-. � I Gas Range " Water Heater.:: .. Gas Elec Basement - Floor 1 11.1-111-1 Floor Floor 3 Floor 4 _.M. M PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas:" Gas Range— <<ti� Ty)I4 Gas Dryer" _ Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance TOTAL JOB ADDRESS6S Q( Ail 5L dt�__L©PJ 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 and rulings of the Building Division, and hereby declares that all the facts State Surcharge $ .50 TOTAL FEE s20.50 and representations stated in this application are true and correct. DANIELSON, BRUCE 7472 MELODY DRIVE NORTHEAST FRIDLEY, MN 55432 Owner _ (763) 786-5145 Building Used Estimated Cost TU PERMIT NO. PLUMBING COMPANY Lj0&f!>L_01"7 Approved By "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. MAY -12-2005 13:41 CITY OF FR I DLEY H.021015 qEW //' r , � - o> 966 ;DPN/ j 7 CITY OF FRIDLEY ALTER6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp 1 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 5'0o2 `f977 Construction Address: "l _114�* Legal Description: _ l 4vmer Name & Address: _ 0r„ Contractor: MN LICENSE # )� _6 0 Address: 2 o zs Go,,..,s. cry lr s 37y Tel. 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 Height___S . Ft. GARAGE � AREA: Length Width ` Height S Ft. DECKAREA: — � �• Length Width Hgt/Ground 5q. Ft. {ETHER: ',onstruction Type;_R,e'r Oy _ Estimated Cost: S )riveway Curia Cut Width Needed: Ft. + 6 Ft = Ft X S 'ATE' • Z • v < APPLICANT: �v �� �-�- (�a� r��-..� Til. # ail (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will calf to for card number. ermit Fee fan Review 're Surcharge tate Surcharge 4C Charge cense Surcharge :orb Cut Escrow 'Osion Control irk Fee :veer Main Charge $ W (:ITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee _001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 per SAC Unit $5.00 (State Licensed Residential Contractors) -Alt. "A" or Alt. "B" Above :450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary[ l Not Necessary[ j TOTAL $ L% / . � STIPULATIONS: