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PRE 2010 DOCS9® e/ City of Fridley, Minn.. N° 7981 BUILDING PERMIT Date: June 22 1965 Oar: Cliff. Vukermann Bider Clemron, Me. Adm 7375 Memory Lane Address 701 Columbia Blvd. LOCATION OF BUILDING No. 7375 Street _ Memory Lane Part of Lot Lot 5 Block 4 Addition or Sub-Divisdon Melody Manor, 3rd Add Corner Lot Inside Lot Setback — Sideyard Sewer Elevation —. Foundation Elevation To be Used as: Single Dwelling DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft, Att. Garage Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame Est Cost $23,800.00 To be Completed Single Dwelling Att. Garage In consideration of the issuance to me of a permit to c building the proposed work in accordance with the description above fo and in Co ordinances of the city of Fridley. _z 14/1 agree to do rovisions of In consideration of the payment of a fee of $ Ng $24.00. permit is hereby granted to Clemron, Inc. 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 an 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 r+e��ardi>ilg 1p�otn,� ���� t a 'time upon�o atimany of tmhoe�progvisions of said ordinances. city limits and this Allen Jensen Building Inspector NOTICE: Ub pe* den net eeru the cendmd1en, kshMs ten for wbht& pWmbin& on hen&& sone or wafer. Be sun to ne the BQMft bspecw for sepmft pwnft for then Yams. i . APPLICATION FOR BUILDING PEPMT CITY OF FRIDLEY, MINNESOTA �i LOCATION OF BUILDING No. �/��� Street I Far of Lot 9 Lot J' Block Addition or Subd ision,1� / Corner Lot' inside Lots Setback Side Y ' SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: Front � — D.::th ei ht Sq. Ft. �® 5^� Cu . Ft.. Front —,0 Depth y /� Height_ Sq. Ft.Cu. Ft. Type of Construction Estimated Cost 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 ar%-Irue and correct, w DATE7 SIGNATURE Schedule of Fee Casts can be found on the Reverse Side). R City of Fridley, Minn. N° 8049 BUILDING PERMIT Date: June 28, 1965 Owner: Vikkermann Builder Clemron, Inc. Address 7375 Memorg Lane Address 701 Columbia Blvd. LOCATION OF BUILDING No, 7375 Street Memoxy Lane Part of Lot Lot 5 _ Block _ 4 Addition or Sub -Division 10da Nuor 3rd- . Add. Corner Lot Inside Lot Setback __ _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Single Dwelling Front Depth Height Sq. Ft. Cu. Ft. Att. Garage Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame Fust. Cost $9-32000000 ___ To be Completed New Dwelling, att. Garage �v� 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 in compliance with aft provisions of ordinances of the city of Fridley. in consideration Of the payment of a fee of $ 26.00 , permit is hereby granted tO Rengl el C _ Johnson Clemroa,, Inc• 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 location, construction, alteration, maintenance, repair and moving of buildings within the city limits permit may be revoked at any time upon violation of any of the provisions of said ordinances. Allen Jensen Big uspector NOTICE Uh permit does not sora the sonstrusthro, Installation for wbin& phmbin& Ba 6eatbm sewer or water. Be sere to aoe the Bdmhw hrspector for separate perp" for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S MIM, ����BVILDER DDR 'DDRV/moi///Z / LOCATION OF BUILDING =� Street r� Part of Lot .LOT ✓� R � ADDITION OR SUBDI ON 1` l � Corner.Lot Inside LOT, �etback­ Side -Yard_ /& 'SSR ELEVATION FOUNDATION ELEVAT$Ok Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING } To be ed as Front_, �W ZI Dept � Height Sq. Ft._ _Cu. Ft.- L� Front DepthfHeight ?S Sq. Ft:__Cu. Ft._��? Type of Construct To be completed -Estimated Costg NEWIFsem/ The undersigned hereby makes application for a permit for the work `herein'sgecified, 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 corgr"t., (Schedule of Fee Costs can be found on the Reverse Side). Land Plainnj 075 -lilfhAVy 005 NE. lav surwy"y ulm"lulism, Smis T rjh�y ENGINEERING, INC. Aflmvvla CIVI/ & mr/c/pai Sdfl,04066 Enyme-enry Engineers ,Surveyors certificate ®f survey cow E*Tn MEW -pm 0 DENOTES IQ0W=----DEV40'TES DRAINAGE AND UTILITY EASEMENT LOT —1j--'BL0CX--4.,--MELODY MANOR 3RD ADDITION ANOKA Ty flint 65 is a true and mrmcimpmsenhhan up sway bwndbries d6dW &S&VAd lal7d, ad I II&Vhy ctri4y' et* X a r* lkqhwDu// bw1dWys,#VvW,and ell "5/Mr w-mqsaid 1Wd- As ivrveyed hynv #0 --dby A-0 11K. SUBURBAN ENGINEERING, INC. Scale, -Ad CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 $ each add. 50,000 BTU 4.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 $ each addn. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING $ S See Fee Schedule $ VENTILATING SYSTEMS $ .ALTERATIONS $ REPAIRS3 $ State Surcharge $ .50 TOTAL FEE $ �� ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT REINSPECTION FEE ($10.00) MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE Job Address 73 7q- 114eiviQ r � Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. / Fridley, Minn. 0 v L . 19 M OWNER /S , C% , KIND OF BUILDING � r �+ �2 r 1P USED AS CW ) VI q TO BE COMPLETED ABOUT / A 0p ESTIMATED COST 7 j> OLD NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER Trade Name rr-)edpick 4,-WAO Size No. J�CA Q30 Capacity Sq. Ft. EDR BTU 30 HP Total Connected Load Kind of Fuel BURNER - Trade Name' Size No. Capacity Sq. Ft. EOR BTU,�� %/ HP Company 5%44 c�/Z� Aide � Signed By �Z Tel. No. C!y I City of Fridley SUBJECT riIM7 3 3 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. : ------ r � � PROTECTIVE INSPECTION SEC. i y 5- 3 � L----� `,� CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY ��--- j 612-571-3450 910-F15 9/24/84 JOB ADDRESS 7375 Memory Lane N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 4 Melody Manor 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Vickermen 7375 Memory Lane N.E. 784-4963 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Meehan Brothers Inc. 2838 Stevens Avenue South 7JM 879-0234 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ElREPAIR [IMOVE ElREMOVE xO 8 DESCRIBE WORK Construct a 2V x 12i Addition to Rear of Dwellin I 9 CHANGE OF USE FROM TO STIPULATIONS Provide fire alarms on both levels. a�o}a9 SEPERATE PERMITS REQUIRE® FOR WIRING, 313m-` IA-l��3 ui �P tu�01 ll� H1=ATING. PLUMBING AND SIGN& sae}il!pl 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 15 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 $13,150 $6.58 WITH WHETHER PECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT P SUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROOTHER STATE OR LOCAL LAW REGULATING CON- $104.50 None ,UCEPERFOR ANCE F CONSTRUCTION. PLAN CHECK FEE TOTALFEE ,VlSeIONIF�-414Y '�� $ 26.13 $137.21 I13NATURE OFC6NTR CTOR OR AUTHORIZED AGENT b(DATE) WHEN PROP ERLALIDATED THIS IS YOUR PERMIT BLDG )NSP r)APV SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) NEW [ ] City of Fridley Effective 4/1/84 ADDN. [ ] �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: Legal Description:Owner Name Name & Address: / '7`�q�y' ����°'F°', Tel. # Contractor: �A66A31e) - 's em Tel. # Address: '�g 3a LIVING AREA: GARAGE AREA: DECK AREA: OTHER• Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF MPROVEMENT Length az` Width 12- .1 Height ---- Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. tFt. 2Gq*A 44M� -=I I I`�ls* Corner Lot [ ] Inside Lot [' Ft. Id. Setback Side Yard Setback Type of Construction: Estimated Cost: $ Approx. Completion Date: I'3,1 S� Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation •DAT ® o APPLICANT:Tel . # 126 0.-2-3yCITY USE ONLY 7 Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 104. -So $ (9-C2 $ 0-10 $ ..e&* $-�� Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] ati tel Laorc.S. land P4",n9 �j / CBIS N� Ks NE. laid sawymy sodsestoy ENGINEERING, INC. c1v?/ tr awmipw Engineers Surveyyvrs — certificate of snirveT : c.E o m DtVtLOam�n�r 1 0 �-1 NOR7'N a DENOTES IRON' ---DENOTES MANAGE AND UTILITY EASEMENT LOT=LOCK L MELODY MANOR 3RD AM ION 11tA 71TT I brrrby car; y Old to is a kw and a wvwf repssa►iotli n o -,arty bw+.�abr�es !Ae fb.w Awj"w lad, snd f!llit /aal�ri ajl'od1 dr ler�wjs , IMbtrn , aadav ns atr avvarhwonis ,,rsy. fns„ r.►,srd And. As swwyed hy nk 166 — _ ay 't D IIAL' SUdUR&W EN61NEERANO , INC. Inmiaws Er Surrgpr-a Scaler 4C 4c I I SUBJECT P City of Fridley wi 1 1 AT THE TOP OF THE TWINS BUILDING PERMIT R COMMUNITY DEVELOPMENT DIV. ~ PROTECTIVE INSPECTION SEC. � r CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/1/98 JOB ADDRESS 7375 Memory Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 4 1 Melody Manor 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David/Mary Burnside 7375 Memory Lane NE 780-4158 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 6.5' x 4' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNME Before digging call for all utility locatimtis REQUIRED BY LAS ARATE P '... �- . _'_;'.'7r-_D FOR MIRING, Hb.; iI� :.zp ':_ .:�,.'rG AND SIGM SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, TYPE OF CONST. CCUPANCY GROUP OCCUPANCYLOAD 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 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 @ $•50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $500 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- $21.00 Fire SC $.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $22.00 SIG RE OF CONTRAWORAULAUTHORIZED AGENT I TE) WHEN PROPERCI VALIDATED THIS IS YOUR PERMIT TATE S.GNATURE OF OWNER IIF OWNER BUILDE IDAT I BLOt INSP I NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress:3 4z IV45 Legal Description: Effective 1/1/98 ,26111 4--71V 153rya Owner Name & Address: _ �� ve r s-� e-„ s . �e �s'�� e� Tel. # (1-2) ;�9Q— Contractor: MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF BIPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length �2 Width `j' Hgt/Ground 5 � Sq. Ft. 96 OTHER: Construction Type: ec% r �(�-e��, free �c� %��� Estimated Cost: $ 6ec:�� (Fee Schedule on Back) Driveway Curb Cut Width Needed: & f Ft. + 6 Ft = Ft x $ = $ DATE: y22— 9� APPLICANT: Tel. # 6/ .2) 7g o e y�-S CITY USE ONLY Permit Fee $ ,x% 8 r� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 02.,7"00 STIPULATIONS: hose ia' P land Planrn"9 .�� �, / GETS N, KS wE. l'w swwyaol �/ 4/irrt�pioys )t. 50115 kstoy ENGINEERING, INC. Fly. -- Engineers Surveyors — certificate of I --4 survey LPN 111 IIOR'�H O DENOTES IRON' ---DENOTES DRAINAGE ANO UTILITY EASEMENT LOTS.=LOCK 4jMELOOY MANOR Uo MOITIOW Iknby ca h y AW Airs a a bw and arnKi reorrmfliah on 4('o mrmy Och baw a v, 45 1k r6em dwjv w! low, and of'11 k /eroAan ayl'otl er.ldr�s , Abrrn , aad a✓/ ►nd qtr axnwhwonh , �,rvy. fnw r w grad Awd As w• -.eyed 6y nst Ai —=- dy '1r � T': A.0 dft' SU6URBAN EMG/NEER/N6. INC. . Emn,.�rs Fr Surrcyars Scale: r, -4C c� ra AY K SUBJECT P IT NO. City of Fridley 29795 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. f ' COMMUNITY DEVELOPMENT OIV. may.-----_ � PROTECTIVE INSPECTION SEC. f f NUMBER REv DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 9104156/30199 99 JOB ADDRESS 7375 Memory La ne 1 LEGAL LOT NO. BLOCK OR ADDITION SEE ATTACHED DESCR. TfRIACT 5 4SHEET Melody 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dave Burnside 780-4158 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Eagleview Const. Tnc- 29.17 174th lane Andover NN 553 A 753-5469 20067043 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 0 NEW 0 ADDITION 0 ALTERATION REPAIR 0 MOVE O REMOVE B DESCRIBE WORK Reroof house and garage 22 S Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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. OWLG. 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 $1923 .96 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $69.25 Fire SC $1.92 r PLAN CHECK FEEL FEE Licen 5e0 iGNAT RE OFC N!RACTOR OR AUTHORIZED AGENT IO TEI EN PRY VALIWTjroTHIS IS Y UR P RMI BL G INSP I gA1f S,GNATURE OF OWNEROF OWNERSUILDERI IDATE. NEW[ ] ADDN ALTER Effective 5/10/99 [ ] CITY OF FRIDLEY [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: FAM Owner Name & Address: U14^)E &t 94w- 00'r Tel. # Contractor: 6;0,4,�4� C MN LICENSE # Address: 2-13% (7 1/ Tel. # 7�3 –SY& Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF E14PROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: ,Rj C4 4—,4, --e R Estimated Cost: ZW few Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: !PA//f2 APPLICANT: Tel. # 7-5-3 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] Not Necessary [ ]