PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: ....� s A. f....�-Q ................
Owner.......................................
Address......................................
N® 3989
Builder .. .................
Address.............................................
LOCATION OF BUILDING
No. .... Street ....... Part of Lot... .... p
...
,,++ �F r�--�
Lot ..14e .... Block ..:4l............. Addition or Sub-DDgivision ......... ............ r ."�,? . .
Corner Lot ............ Inside Lot ............ Setback 411 ' :10.. Sideyard ......0.:�............
DESCRIPTION OF BUILDING
To jbe Used as:.
..... ........... . Front � -.7. Dep . s . Height %% . n ® Sq. Ft. / f? . Cu. Ft.
.................... Front ........ Depth .....�°° .. Height y ....... Sq. Ft. ........ Cu. Ft. ........
Type of Construction .. ...... ......... Fst. Costi.�.�y.7AV.. e q To be Completed ...................
In consideration of the issuance to me of a permit to construct the b g sribed above, I agree to do
the proposed work in accordance with the description abov se orth pliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $PZZ. fb , 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 with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
.... .. ... .P. Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
City of Fridley, Minn..
BURDING PERAUT N? 6768
Date-
kz�z 0
r;a Builder i
i
LO IONPF � ING
No. Street 64 Part of Lot
Lot _ Block Addition or Sub- on
Corner Lot Inside Lot Wtback Sideyard
Sewer Elevation ____ Foun tion Elevation
DESCRIPTION OF BUILDING
To U
Front Depth '_rte Height Z12- Sq. Ft. Cu. Ft.
Front — Depth-Heei)g-,hstt Sq. Ft. _ __ Cu. Ft.
Type of Construction y� Est._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 0 provisions of
ordinances of the city of Fridley. ^ "?
In consideration of the payment of a fee of $SY , permit is hereby
to
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding
location, construction, alteration, maintenance, repair and moving of build1nps
within the city limits and this permit may be revoked at any tib up �viol�io�, of any of the provisions of said
ordinances. l d I
Building Inspector
NOTICE:
M permit does net cam tho comtrostien, hataiWten for wmh& plumbing, gas heaftng, sewer or water. Be euro to no
tho Building hopemr for nparate pwndit for these Nene.
. • .
I 1 P
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAPE'
r
ADDRESS 71_Z &/P r /►/ he ADDRESS 2��KIv A S �$
LOCATION OF BUILDING
No. Street __z2 fLe e rQ y- _Part of Lot -Z
Lot
Block Addition or Subdivision
Corner Lot Inside Lot_2j_Setback
SEWER ELEVATION
Side -Yard 3
FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates. _
To be used as;
DESCRIPTION OF BUILDING
Front �. Depth A :2— Height 7
Sq. Ft. Cu. Ft. , 1 7 ,�
Front Depth Height
Sq. Ft. Cu. Ft.
Type of ConstructionEstimated Cost
To be Completed_ tjC — �, 3
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.
6s S TONATIME 11 L /40/t_�1
(Schedule of Fee Costs can be found on the Reverse Side).
- City of Fridley, Minn..
BUILDING PERMIT
Date: YAY25, 1965
N° 7532
Owner: Ted Radmonovich Builder Alan Construction Inc.
Address 711 Overton Drive, Fridley Address 050 Zachary Lane, Minneapolis
LOCATION OF BUILDING
No. 711 street Overton Drive, Fridley Part of Lot
Lot ___16 Block - 5 Addition or Sub-DivisionZ kdW `I'err&Ce 3rd. .add.
Corner Lot — Inside Lot _ _ Setback Sideyard
Sewer Mevation
To be Used as:
Foundation Mevation
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft Cu. Ft
Front Depth Height Sq. Ft Cu. Ft
Type of Construction Fat Cost -1900'00 Tobe Completed
Storm Repair (Remodel & Repair)
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
orrIinanoEs oP the city of Fridley.��
In consideration of the payment of a fee of $ 10.00 , permit is hereby granted toAlan Construction 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 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.
Building Inspector
NOTICE:
Ibb penult don not aver the eondracdon, instaile w for wMag, ph mbing, gn heedag, sewer or wafer. Be sun to sea
the Bolidiap ingm fer for seperam permhs for dwa Items.
ov
4
APPLICATION FOR B' ING.PERMIT
CITY OF FRIDUE N10E.OTA
OAR'S NAME Ted Ra.dmojoy ch BUILDER Alan Construction Inc.
ADDRESS ..711 O#erton Drive Fridley ADDR2SS 4850 Zachary_Lane, .Minneapolis_ILI_
LOCATION OF BIND
e
No, i Street Part of Lot.
^
Lot I �G° Block Additioar or Subdivisionti� �%� (.&i-�
Corner Lot Inside Lot;.,.<..Side Yard
SEMI- ELE'VATIQN FOUNDATION ELEVATION
Applitant attach to th-i-9 form, Two Certificates, of. Survey of Lot and proposed build-
ing location drAwn on these CA-ttificates.
DESCRIPTION OF BUILDING
To be used as:
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Remodel & repair Estimated ,Cost $3.900.00
_,�0-.be �a'mPleted
The undersigned hereby makes application for a permit for the work herein -specified,
agreeing to coo 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.
J'Schedule.of Fee Costs can be found on the Reverse Side).
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 ........................... $10.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 .................. 6.00 $
Repairs & Alterations each add. $500.00 ............... 3.00 $
MECH. WARM AIR
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 1 .......... x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FEE
Dept. of Bldgs. Phone 560-3450
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 Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and co t.
Fr}cjle�y, � 18 �cQ
Owner 1� -` `--,. -
Kind of Buil g L
Used as
To be completed about
Cifd--New. Building Permit No. Permit No. 1"41
DESCRIPTION OF WORK /1
HEATING or PO am, Hot Water, Warm Air—No-
7
Trade Nam p Size No 0ev -/03&
Capacity. Sq. Ft. E.D.R• BTU H.P.
Total Connected Load 422 6 Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
SUBJECT
City of Fridley
214515
AT THE TOP OF THE TWINS
BUILDING PERMIT
1 ?
RECEIPT NO
COMMUNITY DEVELOPMENT DIV.
_
PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/23/92
JOB ADDRESS 711 Overton Drive NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
16
5
Brookview Terrace 3rd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Michael Boyce 711 Overton Drive NE 571-4824
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
S ame
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 ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace windows & Add sliding glass door; replace siding
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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
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
$10,000
$5.00
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Fire SC $10.00
PLAN CHECK FEE
TOTAL FEE
$132.00
WS AT REOFC R�CTR AUTHORIZED AGENT IOATEI
WHEN PROP LY A d D THIS IScYOUR
�PERMIT '7
'� LDG,NSF' DATE
SIGNATURE OF OWNER OF OWZ BUILDER) (DATE,
NEW [ j Effective 3/1/92
ADDN (] CITY OF FRIDLEY
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: �� a LJt-/�7 -<Y/AUJI
Legal Description: l P n�c- M/Jp u) s c I
Owner Name & Address: /� '' / ' kTel. # �i Ire
Contractor: <<" _ .1 -
MN LICENSE #
Address: Tel n#
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER:
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot [) Ft. Yd Setback Side Yard Setbacks
Type of Construction: ��,,n� Estimated Cost: $ /c2r
Approx. Completion Date:
(Cost on .back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: `? APPLICANT: 7 Tel.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
$ ///`"z'�2e�
Driveway Escrow $
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
$700 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary ( ]
SUBJECT
PERMIT NO.
City of Fridley
2 2 4
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
O.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
113
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE Of
APPROVED BY
612-571-3450
910-F15
5/3/94
JOB ADDRESS 711 Overton Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
16
5
1 Brookview Terrace 3rd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Michael Boyce 711 Overton Drive NE 572-8671
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 16' x 14' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Provide smoke detectors adjacent to all bedrooms
and in basement.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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 80 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 1 HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS I 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
$1,326
$.66
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 -Fire
Fire SC $1.33
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$34.99
SIGNATURE OF CONTRACTOB OR AUTHORIZED NT IDATEIWHEN
P VALvED THIS IS YOUR PERMIT
Gt
SIGNATURE OF OWNER IIF ER OWNBUILDERI IDATEI
8 OG INSP DATE
NEW [ ( Effective 1/ 1/94
ADDN (] CITY OF FRIDLEY
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 41103/
Building Permit Application
Construction Address: —17111
Legal Description: _���,--------- _-- --
Owner Name & Address: Tel. #5--72- 9(D7
Contractor: M I T 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 IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width --� Height ter- Sq. Ft.
DECK AREA: Length I Ce Width Hgt/Groundd Sq. Ft. ,lR-r-'l73
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yrack Side Yard Setbacks
Type of Construction: -fU*AA LJ, Estimated Cost: $ l
J
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft�-a x $ _ $
DATE: 2 c)APPLICANT: Tel.00 #
('ITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $ 1•33 .001 of Permit Valuation (1/10th%)
State Surcharge $ ��� $.50/$1,000 Valuation
SAC Charge $ $800 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 $
STIPULATIONS: „,n
6 / ■
SUBJECT
City of Fridley
3297
AT THE TOP OF THE TWINS
P,RECEIPT
BUILDING
PERMIT
If
NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r f
r 1
1 i
NUMBER
REV
OATS
PAGE OF
APPROVED BY
"'�•� CITY HALL FRIDLEY 55432
i1
----
763-571-3450
910-FlS
8/12/02
JOB ADDRESS 711 Overton Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1 16
5
1 Brookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Mike Boyce 711 Overton Drive NE
763-572-8671
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Mark's Total Home 3209 Roosevelt St NE
St Anthony,MN 55418 612-282-3913
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20328279
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW C. ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 19' x 22' Garage Addition
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notation on plan.
Aa
zoo mv
SEPARATE PERMITS
l Al
sum �iil!io Ile
REQUIRED FOR;
Jot Ileo BUIBBip eioles
WIRING HEAnN
PLUMBING AND Sig S
ek e
SEPARATE PERMITS ARE REQUIRED 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
1 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$8,556
$4.28
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANYTH STAT OR LOCAL LAW REGULATING CON-
$167.25
Fire SC $8.56
TRU TI ORM ONSTRUCTION
PLAN CHECK FEE
T AL FEE
Lice a SC $5. 0
$185.09
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI
HE PR E Y VALID ED THIS IS YOUR PERMIT
t/
I -
9 NS gAfE
IG
SNATURE OF OWNER OF OWNER BUILDERI DATE,
6 / ■
NEW (] CITY OF FRIDLEY
ADDN [ J 6431 University Ave NE, Fridley, MN 55432
ALTER (J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description: a r Q ,
Owner Name & Address: P/f<
Contractor. %�4/,'x S �(
,� & 5 A®o5-,e—ves
p q -n a
r
/4.OV-L
Effective 1/1/2A82---
(763) 572 -SIdg-Irlisp
Tel. # 2(v3—®%.Z" ,r9,6 7/
MN LICENSE # 96-,20 3 �N-Z7 5
Tel. # 12- - 9-F2 3 1 /-)�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
,#bbo
LIVING AREA' Length Width Height Sq. Ft
GARAGE ;;;�- Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
Construction Type: /J ®®c( fe" --1 Estimated Cost:
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$
DATE: T-6 - (D -Z- APPLICANT: '�'ctPe i6'�i ker Tel. # /���2��' >�!•
Call (763) 5724604 for Permit Fees if mailing In application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee $ � Fee Schedule on Reverse Side
Fire Surcharge $ eq -S .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1200 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 $ /951-/)g STIPULATIONS:
IF