PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT Nd 4 6 9 2
Date:
Owner: ... _... ._ _ _..._..___..... Builder _...�
_
Address ... _ __ __ Address
L PPION BUILDING
NO. .., ,..._....... Streei .__ _.. _ ..... _..._......_.._._
Part,9 Lot
Lot ...-_14._ ............ Block ....._............._.. ................ Addition or Sub -Division _:, :.... _. _._. � °4 .......... '
------ i ....... ,�' _......._....-------------•-----------__._.._..
Corner Lot ...--- ..............•-..--- Inside Lot .--------........_-......... Setback ..... ................ Sideyard ..�
Sewer Elevation .............. ........................ _------- _-----.._------------- _...................... Foundation Elevation ................... ........................... '
DESCRIPTION OF BUILDING
To Used
Front �.. Depth ... ....._.. Height .... _ Sq. Cu. Ft. . d 1,4C
0101
1 r
A"Front �3 ...� Depth ...,;, L Height ::._.. Sq. Ft..._ Cu. Ft.
Type of Construction ..---..�7 rte �2. ' .Est. Cost..�,e'- c :..rl. ..........._ To be Completed _...__..._._---._........_-
i
THIS p ERIMI l I%_ I 'UTHf 1 C l'
ION OF7 �,DLAT-
ELILDilf"i icE � f t{PCTiCf�JS', COVENANTS !TJ AND
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 $...,..70............ 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 of any of the provisions of said
ordinances.
�+d
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, .gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these hems.
4
APPLICATION FOR BUILDING PERM
CITY OF FRIDLEY, KMNESOTA
Owners Name Builder
Address Address 1 -�
LOCATION OF BUILDING
No. > '--7Street r,_r,'art, of Lot
Lot ZAL Block ::�— Addition or Sub.Div. -.
Corner Lot Inside Lot_,X Set Back Side -Yard Z;;=
SEWER ELEVATION 9 ,� FOUNDATION ELEVATION 4S L ,�
Applicant attach to.this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Frontfe— Depth .
Sq. Ft. //� S`� , Cu. Ft.
�i ^7 r �l
M
Sq. Ft.
Cu. Ft.
Type of Construction w Estimated Cost
To be
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 representa-
tions stated in this application are true and correct,
DATE IGNATt]RE ...�
(A; ched a of Fee costs can be found on the Reverse Side.)
City of Fridley, Minn. N° 8122
BUILDING PERMIT
Date: July 6, 1965
oar: Martin H. Lueders Builder Martin H. Lueders
Address 6831 Oakley Street N. E. Address
LOCATION OF BUILDING
No.6831 Street Oakley Street N E. Part of Lot
Lot 16 _ Block Addition or Sub -Division _ Hrook -i.ex Terrace_ Ind Addition
Corner Lot Inside Lot
Sewer Elevation
Setback _ Sideyard
M Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front Depth Height Sq. Ft. Cu. Ft.
Double Garage Front Depth Height Sq. Ft. Cu. Ft.
Type of construction POM Est. Cost _ _ To Completed
-.777
Dwelling, Double Ga ,
u
In consideration of the issuan of a perm$t to construct the buil/g described above I agree to do
the proposed work in accrordan description above set forth and in compliance with al provlaton0 of
ordinances of the city of Fridley.
In consideration of the payment of a fee of OR 10.00 , permit is hereby granted to Martin H. Lueders
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 kx :tion, conatructton, 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 sald
ordinances.
Allen Jensen
NOTICE:
Ub peemh don net sown the ambu dw, hntapNion for whdag, plumbing, on hading, ewer or water. Be sae to sen
the Bulling Mweder tar seprA t+ peraft for than hone.
APPLICATION FOR BUILDING PERMIT
1
CITY OF FRIDLEY, MINNESOTA
OWNER'S,��•f�"���f�.S BUILDER
ADDRESS �n�.�� D�/ /`' y S%/ ,s� G ADDRESS
LOCATION OF BUILDING
Street. Part of Lot
LOT �K ADDITION OR SUBDIVISION %_ F_ D ey/t�,%
Corner Lot Inside L Setback Side -;Yard
SEVER ELEVATION FOUNDATION ELEVATIOIL
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:
I �
l/z���/�✓ �ti'..,..� Depth Height
s
w i/'r (5;geA'C
Sq. Ft. Cu. Ft.
th _Height
Sq. Ft. Cu. Ft.eh(
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 are true and correct.
DATE✓L -SIGNATURE���
(Schedule of Fee Costs can be found on the Reverse Side).
Ah
CJS //, /965'
-2, KAINA
,r -414
City of Fridley, Minn. N° 8378
BUILDING PERMIT
Date: AUGUST 182 1965
Owner: MR. LUEDER Builder A. A. HARDY & ASSOCTMONS INC.:
Address 6381 OAKLEY ST N E Address 8417 Riverview Lane
Fridley 21, Minnesota Minneapolis 30, 1965
LOCATION OF BUILDING
No. 6381 Street OARLEY N E Part of Lot
Lot _ Block 2 Addition or Sub -Division . RROOKYTEW TERRACE. inti Addition
Corner Lot Inside Lot Setback Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
HOME Front 43' 6"Dept, 26 Height 20 Sq. Ft 1,118 a,, Ft,22.360
GARAGE Front 22 Depth 21.9geight 10 Sq, FL 462 Cu FL 4.620
7�ype of Construction Fat Cost $17,000.00 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 fortl�.,and in compliance with aft provisions of
ordinances of the city of Fridley. �� 1
In consideration of the payment of a fee of $ 27.00 , permit is hereby granted to A. A_ HARDY
& ASSOC., INC, to construct the building or addition as described above. This permit is granted upon
the expre� condition that the peon to whom it is granted sad his agents, employees and workmen, in all work.
done in, around and upon said building, or any part thereof, shall conform in aII respects to the ordinaac�a of
Fridley, Minnesota location, camstruction, alteration, maintenance, repair and moving of buildings
within the city limits and permit may be revoked at at{y time upon violation of any of the provisions of said
ordinaa�.
ALLEN G. JENSEN Building inspector
NOTIC&
We pemah don mot cosh the construction, huhdholom for whieg, plumbing, gn hating, ower or water. Be sun to as
tin Building hupeeter for separate psrmhs for thew hems.
OWNER'S NAME
ADDRESS i�a 3J'1 'J/4 -
No.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
zadjec
BUILDER tl ° 6?` �/t r
ADDRESS �41 7
��.
OF BUILDING
STREET _PART OF LOT
LOT BLOCK ADDITION OR SUBDIVISION I
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.
DESCRIPTION OF BUILDING
To be used as;
Front G/3 16.1 Depth ;9- (o Height d
flig". /8®vv" /2 X 2Z
Sq. Ft. 1, irk Cu. Ft,
Front vZ Depth Height /D
Sq. Ft. `7 02 — Cu. Ft.
Type of Construction t Estimated Cost l %i0 od
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 --t� 6-� SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
EGANy FIELD & NOWAaC
SURVEYORS
119 WEST LAKE fTREET $� E �lf t7 MINNEAPOLIS 9, MINN.-
MORTGAGE LOAN SURVEY i�
CERTIFICATE OF SURVEY
For THORPE BROS,
N!�4 n
f 3110,
5 of
p ,+ C?
cr 00 00
Ld
...,i o 24.1 f ,
Y SO: '
Q o — 123.49
UC 1
North line of 68A Ave.
DESCRIPTION: LOT 16,..BLWCK 2, BROeKv.etw TERRACE 2NO ADO I T I ON,
SCALE: I" - 301 LOAN No. 38452-F
SITUATE IN THE COUNTY OF ANOKA, STATE OF MINNESOTA.
We hereby certify that this is a true and correct representation of a survey
of the boundaries.of the land above described and of the location of all
buildings,.If any, thereon, and all visible encroachments, if any, from or on
said land. This survey is made only in connection with a mortgage loan now
being placed on the property and no liability Is assumed except to the holder
of such mortgage or any other interest acquired by the reason of such
mortgage,. It is understood and agreed no monuments have been placed for the
purpose oV establishing lot lines or boundary corners.
Dated, this_-- 16,rm day of DECEMBER 1960 EGAN, FIELD b NOWAK
Surveyors
4.
File No. 8 0 Nom. b
5773 Q 1540 17 y ;1'°f� ►.
orifi
PERMIT for Power Plants and Heating. Cool-
ing, ventilation. Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of /nHeating Plants �1 to be installed—altered—repaired
Make Size 3d
Oil fired-, Coal fired ; Gas fired ; Gas Authorization
Remarks
Approved
Final Inspection
19_
Inspector
3'd- 6 L�
Permit N? 4782
Fee $ E'> OD
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. S , 192
Owner
Location 6 pq / 0—akL -1 x
Kind of Building — 7rJZQ a2 1.
How Occupied d 1d J
Work to be Commenced—,19—
To
ommenced ,19_
To be Completed ,19%D
Estimated Cost, $ A6.06
&New, Building Permit
Permission is hereby granted to A -ek) L' A J J[ n to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specificatio set forth in the approved application for this
permit on file in the office of the Inspector of Buildings.
,Inspector of Buildings
.0153> 42 2M I I -W N
ApP for Pourer Coolies. V nR Refir%erMon and
Air CondiAmIng System and Devk=
PARTIAL RATE SCHEDULE Dept. of Bld9z. j Phone OW -3M
GRAVETY WARM AIR: RATE TOTAL Lochia (�16 631 l (00
Furnace Shell & Duct Work ...........................$10.00
$
Replacement of Furnace .............................
6.00 $
Repairs & Alterations—tap to $500.00 ..............
.. 6.00 $
Repairs & Alterations each add. $500.00 ...............
3.00 $
MECH. WARM AIR
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 &Famines—to 400 sq. ft. FDR Steam .
.. .$10.00
$
Furnace Shell & Lines ---to 640 sq. ft. EDR Hot Water
.. I0.00
$
Each add. 200 sq ft. EDIT 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) .........................
8.00
$._
over 199,000 BTU See Fee Schedule
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x$ 100
$
Additional Fixtures .................
x .75
$
Gas Range to 199j ti ..........
1►IR CONDITIONING
$
FAN HEATING SYSTEM
See ' Fee Sehednte
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAI. q- 1-7-?(
TOTAL FEE $,
City of Fridley:
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 representations stated in this application are true and correct.
Fridley, Minn- 1 lax
u
Owner �1/i� �([ (yiy
Kind of Building
Used as
To be completed about
Estimated Cost, $ O o O
OI New. Building Permit No. Permit No.
OF WORN
Tiede Name- Size No d - re(')_;�
Capacity ltk ��?y) Sq. Ft. E.D.R BTU _3 C C) H.P.i3
Total Connected Load Bind of Fuel ,
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R- BTU SF
(REMARKS -OYER)
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE
SCHEDULE
am
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
is
$ 5.00
u
Future Fixtures
x
d
$
Mater
$ 1.50
$
Beer Dispenser
a
$ 4.00
l�
ha
e a
$ 5.00
p
q M
w�
w
$
Bain Mater Leader
Heater
$ 5.00
$
Hydraulic Valve
$ 5.00
S
Sump or Receiving Tank
14:
$ 5.00
S
Nater Treating Appliance
41
$ 7.00
$
Hot Nater Heater
$ 5.00
$
Gas Range
$ 10.00
$
Gas Dryec
$ 10.00
$
Back Flow PCOVentsr Required.
o
8
ua✓�m
Type
S 5. UO
H
e
a
u
a
It of Value of Fixture or Appliance
y
$
o
H
w
u
�' s
g
3
o
s
'lac
s /ses-0
Ii
a°.
o�
ti
lot
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(') - Now Fixture, Old Opening
water
RATE
SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$ 5.00
$
Future Fixtures
$ 3.50
$
Old Opening, Now FiatuTe
$ 1.50
$
Beer Dispenser
$ 4.00
S
Blow Off Basin
$ 5.00
$
Catch Basin
$ 5.00
$
Bain Mater Leader
$ 5.00
$
Hydraulic Valve
$ 5.00
S
Sump or Receiving Tank
$ 5.00
S
Nater Treating Appliance
$ 7.00
$
Hot Nater Heater
$ 5.00
$
Gas Range
$ 10.00
$
Gas Dryec
$ 10.00
$
Back Flow PCOVentsr Required.
Yes ( ) No
( )
Type
S 5. UO
$
ALL OTHERS AND/OR REPAIRS AND
ALTERATIONS
It of Value of Fixture or Appliance
$
State Surcharge
S .SU
twinapeccion Fee $
(515.00)
TOTAL
FEE
s /ses-0
Effective May 1, 1990
Jab Address &Iys z 0)0 ..Q
Department of Buildings
City of Fridley
Tel. 0571-3050
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 declare• that all
the facts and representations stated in this a 11 tion are true
true an�rrect
Fridley. Mn. r d Iy
OWNER
KIND OF BUILDING �� T I dntUl -
USED AS 1 J( 2i e I I.- n
TO BE COMPLETED ABOUT
ESTIMATED COST
0
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company l
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP. ` 'f —
Date
APPROVAL FOR PERMIT
011NIMUM FIX FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 SThTE SURCHARGE
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE ;
Frialey, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
Basement
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Wash
Auto.
tprirkn><>`
Floor
Urinal tub :Shower
ilnis':: Tray Fptant :; Drain Basin. Washer
Effective On March 1, 1996
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater —Electric
$ 7.00
Water Heater — Gas**
$10.00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
50
Heater
Elec
The undersigned hereby makes application for a perm it 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
and representations stated in this application are true nd come
Owner 5,7/ — L16 (S/
Building Used As
Estimated Cost W -11,PERMIT NO. �C ° d
PLUMBING
Cn
CC
!i z
®� =5
03
Eigluiz
:34 CO)
040-
'LU
40J'LU 0
®C�d;5
CCt
Z5�
SIGNED BY TEL N0.
Mz MAS1U L.i ,CL 0 566
Approved By Rough—In Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00
$ Z0.50 PLUS THE $.50 STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES.
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
I APPLICATION FOR PLU
MARK NUMARR no mym ima-a rn cc
FITTING PERMIT
/ -
Effective On January 1. 1997
:Wats;>��
s:::t:».:
RATE TOTAL
�Batli`
><::
':u
`f;::.}.: �:;
Wash
: •,:�{ >;::•.:.:}-'-:;;,:
Dike ct:>R:
Auto.
Ga
Gas
.M ;`
Water Heater
Stones :...:.......
Ctc.`s::
Urinal
"Culrr
..
$ 7,00
Water Treating Appliance
_`
<:
$ 7.00
:.
$10.00
Gas Range"
$10.00
Gas Dryer**
Shower SC`:
Tra
Fdn -
.•.•.?�r•.
Washer
:k p;:::
Range
F6d Y,-<:_}�::
GasElec
Basement,
' .<,lii}i`;::¢:'';i::
Yirk-+`?;ry -:
..::.•.: •.
Floor 1
:.a
#
t
Floor 2
�,:;..;•
'
Floor L:?) �:
3 '°:<;
::.iv..•.
».<:. ,
v}<;::.•::.ef..�.
:f•:
�:.:� i.<•..
:dS•i}i}p�i..� •Y..::
<•::.:
:i>F'-:::-;:;iti
:{ •.,-:
,.�•,:
�.}<}:
N.
••.}a•:
Floor 4
j:..
. :.�.
:: }. .S
lit
PLUMBING FIXTURE RATES: NO.
RATE TOTAL
New Fixtures
$ 7.00
Old Opening. New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Recewing Tank
$ 7,00
Water Treating Appliance
$10.00
Water Heater —Electric
$ 7.00
Water Heater — Gas**
$10.00
Gas Range"
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ 5o
JOB ADD " 93 ®K ,4�- �5T'- NF_
The and ereby makes application for a permit for the work herein
sp. o do all work in strict accordance with the city codes
and rutin Bolding Division, and hereby declares that all the fads
and rept stated in this application are true and correct
;=. a PERMIT
SIGNEQTEL NO. /1
Ap
TOTAL FEE PLUS
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A)
lir
i Date Final
MINIMUM SIZE 9 SO INCHES.
3
Building
PLUMBING
Permit No.:
InspectionsRESIDENTIAL
APPLICATION
Received syr
763-572-3604
CITY OF FRIDLEY
Datd
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS $�...� L ars �.�r.c✓
Marty Lueders
THIS APPLICANT IS: ❑ OWNER �ONTRA
6831 Oakley Street
PROPERTY . AME: Fridley MN 55432
OWNER/
TENANT ADDREss: 7635714615 _NATE ZIP
PHONE:
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE # O EXP DATE
YOUR STATE ADDRESS- I'keI / CITY�,g /J STATE,&A6 S�fy09'
LICENSE WITH ' PHONE4;; — x/03 FAX —
APPLICATION -
PERMIT TYPE
SINGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK %
PER MS 16B.665 the permit fee is a minimum of $15.00 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. 01is.should_reflect only. the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost: of labor x.05 =
=•FQR3'ROJEETS WHERE LABOR IXCEED900; FEES ARE BASED ON $10.00 PER FIXT[lRE; EXCEPTi EIRE POTl4:FICTB: (INDICATE TOTAL'
NUMBER OF EACH BELOW)
_ BATH SINK/LAV _FLOOR DRAINS _ SHOWER _ WATER PIPING •
—BATHTUB _ GAS PIPING (mm cnvumst) _ S WRVIMING POOL—WATER SOFTNER ($35)
_ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15)
DISHWASHER --LAUNDRY TRAY LWATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
Permit Fee $
Number of fixtures @ $10.00 X$10, 00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15,!)O = $
Number of fixtures @ $35.00 __ x $35.00 = $ 3S.00
TOTAL DUE $
State Surcharge = $ .50
Total = $ O
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 withouta permit; that the work will be in accordance with the
approved plan in the case of work wh' requires review and approval of plans:
' / /
SIGNATURE OF APPLICANT PRINT NAME JtT Na/C/DY 1 DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-5024977