PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date:
Owner:_._. f ... ......... Builder ,< s� aE�i�?'=�'-�• :..._•_--
Address _... •�,� Address
�OCATI OF BUILDING
No.Street _._ "_:.-- • -_:___............................ .._..._ Part of Lot ............
Lot..... . ..................... ._....... Block ... - -- ._.......... -- ....__......_ Addition or Sub-Divisi..... -......................... •-------• - -- ,.._,..._...
CornerLot ...---.......-----.... Inside Lot ..... ..... .......................... "back ..... ..:_: Sideyard ... .. ........................... ....... .............. --
Sewer Elevation....._..------••---------._.._.._....___.—__.._..._.___.___. .._. FouLtion Elevation _.................._........_. _.
DESCRIPTION OF BUILDING
To be = sed as:
W .... ..I ..... ....... _.... Front .... _.. _ Depth rr++ -� -. Height Sq. Ft. Cu. Ft.. �,•
_.............—
--- ...... n __............._.. Depth ............:... Height .......:Sq. Ft. .............. -----.. Cu. Ft. ................
Type of Construction ......... ......: Est. Co ........., ,,�.?.,�.. .....:......... 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 in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $. . permit is hereby granted to.---_--•-.-----------.- ......... ...— .......... _.
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it. is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation -f any of the provisions of said
/J
ordinances. / 7 �+ i
Inspector
NOTICE:
This permit does not cover , the construction, installation for wiring, plumbing, gas heating, sewer or wafer. Be sure to see
the Building Inspector for separate permits for these hems. CAUTION
d THIF '�'€RMIT DOES NOT AUTHORIZE VIOLATi
lanow-
10N
A'Y R-,ivATE LXND COVEN, AND
APPLICATION FOR BUILDING PM01IT
CITY OF FRIDLEY, MINNESOTA
Owners Name
zks !��c! Builder 60 °
/ 6`0 �i
Address f10 ® ,g,�rS 9 T ;p i 2%;�Cldress
LOCATION OF BUILDING
No. 0 Street %li g r P S S,�° t of Lot
Lot Block , Addition or Sub.Dive�
Corner Lot P�Inside Lot= t Back Side -Yard
SEM ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front '� Depth Height
Sq. Ft.Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
_E/ei/v7� Estimated Gosh � �
Type of Construction,4�
To be completed
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all, work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and represent&-
tions stated in this application are true and I ect.
c -
DATE, — / - ® SIGNATURE
A Schedule of Fee costs can be found on the Reverse Side.) St/ S' ����" ��
BSI'$_ r . , ®0 fid'' Ani -ON
A?InePYPV�
...................................................................................................................
Property T ne
OF e-
cX
Please notify Arline of any fill or extra
concrete used and advise the customer be.
fore pouring slab,
MEQ V 00 At
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.................... _........... ...... ... _. PrCa 2rt� 7�3n@
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City of Fridley, Minn. N? 10487
MOVING X PERMIT
Date: November 7, 1969
owner: ,John Rasmusson Bider Same
Address 1200 Mississippi Street N.E. Address Same
LOCATION OF BUILDING
No. 12..0.0 — Street Mississippi Strpat N.Fj-, ._._... Part of Lot
Lot l____ --- Block - 1 — Addition or Sub -Division . Moen Highlands Ffirst ddn.
Corner Lot —XInside Lot
Sewer Elevation
Setback —_ Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Move Garage on Front 20 Depth 22 Height 10 Sq. Ft. Cu. Ft.
1 o t Front Depth Height Sq. Ft. Ca. Ft.
Type of Construction _ Frame Est. Cost $Xu= 500.00 To be Completed May 30, 1970
In consideration of the issuance to me of a permit to construct the building described above I agree to do
�ordinan of twork
he In of Fri edl y with the description above set forth and in compliance with 21 provisions of
In consideration of the payment of a fee of $—.5. 00 , permit is hereby granted to Mrs • Rasmus son
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 inound and upon said building, or any Bart thereof, shall conform in all respects to the ordinances of
7diyj
ennesota regdiu�lhin citylimitsand thusinances.
NOTICE:
?Ids permit don not corer the construction, h atallation for wiring, plumbing, gn heating, sewer or water. Be ane to we
the Building Inspector for separate permits for then itenm
APPLICATION FOR BUILDING PERMIT
CITY.OF FRIDLEY, MINNESOTA
OWNER 'S NAME l � - t, _ �,. BUILDER
ADDRESS /-=��' % �� 'y __' %/G� ADDRESS
LOCATION OF BUILDING
STREET
LOT / BLOCK / ADDITION OR SUBDIVISION:` -
CORNER LOT INSIDE LOT SETBACK SIDEYARD
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this form Two Certificates of Survey of Lot and
proposed building location drawn on these Certificates.
- ' To Be Used As:
DESCRIPTION OF BUILDING
Front L Depth Lh Height
Square feet Cubic Feet
Front r <' Depth Height
v
Square feet Cubic Feet
4qd
Type of Construction ,�,� ,-,� --� Estimated Cost e e d. oma
To Be Completed /I
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 Z2 le r SIGNATURE . `t'
(Schedule of Fee Costs can be found on the Reverse Side.)
7
e,L7 1
t
Z,e I, -e --
l�
City of Fridley, Minn. N° 10488
BUILDING PERMIT
Date: November 7, 1969
Owner: _ John Rasmusson Bider Same
Address _.120D Misais-Gippi Street LITE AddressSame
LOCATION OF BUILDING
No. 1200 Street Mississippi Street N.E. _ part of Lot
Lot _ _1 _ Block
Addition or Sub -Division .—ManvP Lnktm uigbinnrls First_ Addn.
Corner Lot — X Inside Lot — Setback
Sewer Elevation
To be Used as:
Addition Front 13 Z
Front
Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
Depth 16
Depth ____
Height 20'
Height
Sq, Ft. 216'
Sq. Ft.
Cu. Ft.
Type of Construction — Frame Fst. Cost $2,000-00 --To be Completed ...._ Mai 30, 197
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 ah provisions of
ordinances of the city of Fridley. _ n
In consideration of the payment of a fee of $ 5.00 , permit is hereby granted to Mrs. Rasmus son
thto construct the building or addition as described above. This permit is granted upon
e 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 pari thereof, shall conform in all respects to the ordinances of
Fridley, Mixmesota regarding' location, construction, alteration, maintenance, repair and. moving of buildings
within the city ]units and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Iiispector
CLARENCE BELISLE
NOTICE:
'fids penult does not cover the construction, installation for whing, ph-bing, ens heating, sewer or water. Be sure to no
the Building Inspector for separate psrmhs for these items.
. - I
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER 'S
NAME
BUILDER
ADDRESS
Aed
`/fG`
ADDRESS
LOCATION OF BUILDING
NO. STREET
LOT / BLOCK / ADDITION OR SUBDIVISIONS
CORNER LOT 1xa--� INSIDE LOT SETBACK SIDEYARD
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this form Two Certificates of Survey of Lot and
proposed building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front Depth Height
Square feet ')-/ 6, Cubic Feet
Front --;2 --1 Depth Height
d�
Square feet Cubic Feet _
Type of Construction EstimaEed Cost Z2 a o s. 0--d
To Be Completed 4-) ci N ? > 0'
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 // % �G SIGNATURE
(Schedule of Fee Costs can be found on the vReverse Side.)
q LJ B
P
{� 'S.
I HERESY CERTIFY THAT THIS IS A TRUE AND CORRCCT PLAT
OF •A SURVEY OF LOT 1 s BLOCK -1 t_ OF tIOORE LAKE H I GFILANDS
1ST ADD I T I ONS, CITY OF FR I DL EY�Afir_lKA COUNTY,!:' I NN ESOTA
.AS SURVEYED L>Y 1.1E THIS 3RD DAY OF OCTOBER. 1969.
SIGNED
CARTWRIGHT AND OLSON
HARVEY A. CARTWRIGHT
®� �
COMBINING THE RECORDS OF
J. E. HILL, CIVIL
ANOKA COUNTY SURVEYS
ENGINEER
ESTABLISHED 1896
COUNTY SURVEYS
NEMINNE
LA ND SURVEYORS
MINNEAPOLIS SURVEYS
C. F. SANDHOFF
8410 PALM STREET N. W.
REGISTERED UNDER: LAWS OF STATE OF MINNESOTA
CIVIL ENGINEER
ESTABLISHED laoe
SUNSET 4-7685
LICENSEO BY ORDINANCE OF CITY OF MINNEAPOLIS
OWNER
328 PLYMOUTH BUILDING FEDERAL 8-8721
JAMES NELSON
SURVEYOR
INDUSTRIAL — JUDICIAL
HENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA
ESTABLISHED 1922
BUSINESS — TOPOGRAPHICAL
+ fi �ertifkilncatt
1;1rbm
METROPOLITAN LAND
CITY LOTS — PLATTING
I ..
l.
SURVEYORS, ESTABLISHED 1951
�..�
no
P
{� 'S.
I HERESY CERTIFY THAT THIS IS A TRUE AND CORRCCT PLAT
OF •A SURVEY OF LOT 1 s BLOCK -1 t_ OF tIOORE LAKE H I GFILANDS
1ST ADD I T I ONS, CITY OF FR I DL EY�Afir_lKA COUNTY,!:' I NN ESOTA
.AS SURVEYED L>Y 1.1E THIS 3RD DAY OF OCTOBER. 1969.
SIGNED
CARTWRIGHT AND OLSON
T
r
ct) 24 3
,
SC,6
n .34.8
�� •
O
�..�
no
m �
,a
P
{� 'S.
I HERESY CERTIFY THAT THIS IS A TRUE AND CORRCCT PLAT
OF •A SURVEY OF LOT 1 s BLOCK -1 t_ OF tIOORE LAKE H I GFILANDS
1ST ADD I T I ONS, CITY OF FR I DL EY�Afir_lKA COUNTY,!:' I NN ESOTA
.AS SURVEYED L>Y 1.1E THIS 3RD DAY OF OCTOBER. 1969.
SIGNED
CARTWRIGHT AND OLSON
97-81,-416051 CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE
SCHEDULE
A
PLUMBING FIXTURE RATES:
NO.
RATE
a
Number Fixtures
ro
$3.00
r4
Future Fixture Opening
1
o�
$
Water
m
m
oo
Catch Basin
e
$5.00
$
o+
R »+
N
$5.00
$
++
ri
a,
a'
W
g
Water Softener
Heater
$7.00
a
s
x
$5.00
m
Electric water Heater
x4
$5.00
W
ACea
ay
W
$3.00
$
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
u
a
y
3
4
k
R 3
o
lec
C4
uo.
U3
C� wro
t�
c�
as
1st
dr
rer
2nd
3rd
4 th
-t
I
F7
(R) o Future Connection Opening
Connected with Sewer
(�) a New Fixture, Old Opening
Water
PARTIAL RATE
SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
Electric water Heater
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures
x
$3.00
$
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
REPAIRS 5 ALTERATIONS
First $100.00 $5.00 $
each add. $100.00 or fraction $2.00 $
State Surcharge $ .50
TOTAL FEE $ 8.00
REINSPECTION FEE
($10.00)
Job Address 1200 ATE Mississippi
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 roprosontations stated in this application are true and correct
Fridley, Mn. 6:,719 -2 -
OWNER Vagovich
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT 6-1479
ESTIMATED COST 40.00
OLD - NEW BUILDING PERMIT NO. PEP14IT NO.
Company -0 el --4- z6v�Jf+�
Signed By MINNEGASCO
Tel. No.
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE S()RCHARGE
SUBJECT
P
City of Fridley
3 04 09
AT THE TOP OF THE TWINS
BUILDING
PERMIT
�
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
f I � PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
l J` 612-571-3450
910-F15
10/15/99
JOB ADDRESS 1200 Mississippi Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1I
Moore Lake Highlands 1st Addition SHEET
2 PROPERTY OWNER MAIL ADORES,
ZIP
PHONE
John Dolney
586-9911
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Owner
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
8 DESCRIBE WORK
Reroof garage (8 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
SEPARATE PERMITS ARE REOUIRED 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 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$699
$. so
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
29.60
Fir SC . 70
PLAN CHECK FE
TOT FEE
0.80
SIGN UR OF CO _ ACTOR OR AUTHORIZED AGENT IOATEI
HEN ROP
L VALIDA THIS IS YOUR PERMIT
V
o NATURE OF OW NEA FIFO ER BUILDER. IDATEI
Bl INSo
it
NEW[ ] Effective 5/10/99 rn
ADDN [ ] CITY OF FRIDLEY�" 1
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: ST_
Legal Description:
Owner Name & Address: �-ScLH y,? Tel. # , �V-
Contractor: Pj a. MN LICENSE # Iva
Address: )ZC) SS_ �3E Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft. RR`(
GARAGE AREA: Length .Pb Width JD Height Sq. Ft. #db
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: RE �06F bPrk +6F_ E. �"sG. k � J otu-1
7)
Construction Type: PF -kDol: Estimated Cost: $
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: c: -q�
APPLICANT:
Tel. #
CITY USE ONLY
Permit Fee
$
,66
Fee Schedule on Reverse Side
Fire Surcharge
$
"7 G
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1050 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 [ J
TOTAL
$
o
STIPULATIONS:
•
SUBJECT
P
City of Fridley
'32452
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r ,
i
-ReCOPT NO.
L
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�®
1 ; �
NUMBER
NEv
IIA7E
PAGE OF
APPROVED By
I 1 1 CITY HALL FRIDLEY 55432
.''
612-571-3450
910-F15
3/8/02
JOB ADDRESS 1200 Mississippi Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
Moore Lake Highlands 1st
Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
John Rad 1200 Mississippi Street NE
763-586-9911
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Central Contracting 10609 Meadow Lane, Brooklyn Park,
MN 55443 763-427-6692
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5163
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof House (20 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 A13ANDONEO 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
$2,144
$1.07
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
ROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON -
Fi SC $2.14
S CTION/ PERFORMANCE OF CONSTRUCTION
TIO
PLAN CHECK FE
TOT FEE
Licen S $5.0
$ .46
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
EN RO
ALID TE HIS I OUR PERMIT
BL 07 INSP
TIATE
S,GNATURE OF OWNEROf OWNER BUILDER, IDATEI
0),
NEW [ ] CITY OF FRIDLEY Effective 1/1/2002
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 672-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: D 0 riC Sfl 5S' h p�► 5'� . P_
Legal Description:
Owner Name & Address:
p -o
Contractor. ,e krw 1 Qn.-(-co, 01 MN LICENSE #
Address: / 0 bo cl i' /e ��-n ..✓ �� faro bY4 ate► A& MA/ Tel. # 96 66 Fat
6r1— iia-7gS��
Attach to this application, a Certificate of Survey e
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
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: ��'� o ��/ ��- �`�U / Estimated Cost: $ �' f
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$
DATE: D 6 APPLICANT: 464A VeK Sir, Tel. #
Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 76$-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ 63. c Sr Fee Schedule on Reverse Side
$ _�. /y" .001 of Permit Valuation (1/10th%
$ /,07 $.50/$1,000 Valuation
$ $1200 per SAC Unit
$ ® 6 $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 [ ]
$ 91 y(p STIPULATIONS: