PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: .... d;+ffie , 2.4 ,1939 ..................
owner.......................................
Address ......................................
N® 3979
Builder .. ®. BeIIBOII
..................................
Address .............................................
LOCATION OF BUILDING
No.. ...... street .. hmdora, .. D ive N Lt ...... ... part of Lot
...............................
Lot ...0........ Block ...... 3 .......... Addition or Sub.Division .... Broo�� tnT�BceS . �. Addne
Corner Lot ............ Inside Lot ... $ ....... Setback .35V!.... Sideyard ..3.0 �+ ..................
DESCRIPTION OF BUILDING
To be Used as:
...?B ...... Fronts. Depth 12.!? Height 19!P". Sq. F't r.:. cu. Ft.?.
.................... Front ........ Depth ...... Height ........ Sq. Ft. ........ Cu. Ft. .......
Type of Construction ................... Fst. Cost ... #12f.C%6.4AQ .... To be Completed .............
In consideration of the issuance to me of a permit to construct the
the proposed work in accordance with the descriptionforth
ordinances of the city of Fridley. ( \
�ll'«.' ✓.if
above, I agree to do
with all provisions of
In consideration of the payment of a fee of $... ArLWX ►..., 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. ,
Lid
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, Mian.
BUILDING PERMIT N® 4 s 3a
Date:
Owner:.... Builder ................... _.__..... _....,..._......__..........
___..___...___.._._._._..___._
Address ' -' Address
Y�} LOCATION O BUILDING
No. ......0....... Streei Part of Lot -.- ....... _.._.w_ _ _._.___.........
Lot ....._.. .. ................ Block ....._... ......_................. Addition or Sub-Pivisign , �,r .. __ .r...._.....
Corner Lot _----------------------- - __- Inside Lot ----- -------- "''� ....... Seiback: i 21.4ak e, Sideyard _..._.......-..................... _........... _... _.....
Sewer Elevation ............... _.......... __.__.._....--•-----------_._..._...._...__. Foundation Elevation ............ ............. . _..__......
DESCRIPTION OF BUILDING
To b� Used as:
Front _ Depth .:.--..+ Height - a±'s� Sq. Ft. ,,-- cu. Ft..!
- .........- -,, -......._.............. Front ._.._............... Depth .........--.... .�eiht .......,. _.. Sq. Ft......_......._...._.. Cu. Ft. _..---...-----..._..
�. s�+ Type of Construction .--- _p : ?G ..._ Est.Cost....... _........ To be Completed ............... ................. --....._...._..
CAUTION
THIS PERMIT DOES NOT AUTHORIZE VIOLAT-
ION OF ANY PRIVATE LAND COVENANTS AND
BUILDING RESTRICTIONS.
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 thea �7'""r
p yment of a fee of $...�._:___..._._....., permit is hereby granted ............._..
—_._..__.__._.. .._.. _ _._....._ 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. it 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.
APPLICATION FOR BUILDING PERW
CITY OF FRIDLEY, MINNESOTA
Owners Name
•(:;:,LOCATiON OF BUILDING —2A
Lot
,�
No. �-" Street Part of Lot �I�yV1`��--
Lot j� Block,� ' Addition or Sub,Div. .3 :4
Corner Lot Inside Lot_,�Set Back %� Side�Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
.c-� DE IPTION OF BUILDING
To be used as:
v.
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft,
Type of
To be
Construction "X ��' Estimated
mnlAted
cost���� _
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 Arreo.. � A
DATE!6�/ �Z _ SIGNATURE - .
(A Schedule of Fee costs can be found on the Reverse Side.)
#--3 �//P%
City of Fridley, Minn. N° 8985
BUILDING PERMIT
Date: AUGUST 29, 1966
Owner: ELMER J. VOLK Builder SAME
Address 820 PANDORA DRIVE N.E. Address
FRIDLEY, MINNESOTA 55432
LOCATION OF BUILDING
No. 820 Street PANDORA DRIVE N.E. Part of Lot
Lot 6 _ Block 5 Addition or Sub -Division BROOMEW TERRACE, 3rd Addition
Corner Lot _ Inside Lot _ X Setback Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
ADDN. TO PRESENT Front 15' Depth Height Sq. Ft. Cu. Ft.
GARAGE Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction FRANE Est. Cost —AM-0.9-0— 0.9___ To be Completed
In moderation 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 sgt forth and in compliance with ail provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of S 4.00 , permit is hereby granted to XR J. VOLK
to construct the building or addition as described above. This permit is granted upon
the express condition that the peon to who!u:
is grantertifons
hisdonin, around and upon said building, or arttherhFridley, Minnesota location, conson,altermaintenance, repair and moving of buildings
wiordn n city limits permit may boked at at>,y timeupcn violation of any of the provisions of said
Notices
Uhl pwmh den rmt ems the eemimet en, iastatldlea for r►Mh& plumhleg, gn hosting, sewer or wster. Be sun to see
tis Building ImpMor for sopmte pwmbs for thea hems.
OWNERS NAME
ADDRESS Si L ZI tl ef o ADDRESS
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDL'EY, MINNESOTA
LOCATION OF BUILDING
NO. STREET .Y- , PART OF LOT
LOT BLOCK ADDITION OR SUBDIVISION tet/
CORNER LOT INSIDE LOT"2�,_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 Depth Height
Sq. Ft. Cu. Ft.
Front Dept `Height
Sq. Ft. Cu. Ft.
Type of Construction_ Estimated Cost o0 0
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 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse S de).
1)— /-/'� r'*d" CITY OF FRIDLEY Effective Date May 1, 19ae
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL `
RATE
TOTAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
$
20.00
$
Gas Piping
$
10.00
S
(piping needed with new furnace)
Gas Range
$
10.00
$
Gas Dryer
$
10.00
$
* Air Conditioning (all sizes)
All Others/Repairs and Alterations
It of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
e 1% of Value of Appliance or Work
n
$ 10.00 $
Job Address
Department of Buildings, 6431 University Ave. N.E., Fridley, MH 55432
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.
AA // Fridley, Minn. 19 4,6
OWNER
KIND OF BUILDING =2L=,:a,
USED AS
$ TO BE COMPLETED ABOUT �e
ESTIMATED COST���
State Surcharge $ .50
TOTAL lZ:E $-24—fir.
heinspection Fee ($15.00) $
Rough Insp.
Date
Final Insp. ::� Z — o
Date
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
OLD - NEW BUILDING PERMIT NO.
PERMIT NO. /0')'/
'% y f
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. R
Trade Name Size Size No. �5C! �/� %� _ %d
Capacity iib 0 Sq. Pt. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
A /h A Company
Signed By✓i1��
MINNEAPOLIS, [�"'A 544, J Tei. No.
£l1-SOGO
Fill out back side for stack verification on replacement furnaces
1
C17YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 643 j UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
May 7, 1993
Roxanne Cain
820 Pandora Drive iI.E.
Fridley, MN 5543
RE: Property at 8$0 Pandora Drive N.E.
Dear Ms. Cain:
This letter is to cl nfirm the information which we discussed in our
recent telephone co versation. At that time, I agreed to grant you
an extension of ti a to comply with the terms of my April 5, 1993,
letter. It is expected that you will take action to bring the
vehicle (857 EGA) into full compliance with the Fridley City Code
by improving it to,currently licensed/street operable or removing
it from public view.
I will reinspect your property on
as which time full compliance is
at 572-3595 if you ave questions
Thanks for your coo eration.
Sincerely,
Steven Barg i
Code Enforcement Officer
SB:ls
CE -93-209
or shortly after June 1, 1993,
expected. Feel free to call me
or wish to discuss this further.
SUBJECT
City of Fridle
C
618 4
AT THE TOP OF THE TWINS
I' I I D I N G P E R
BUILDING
AA I T
r
Dv L \J
1r1
______ I COMMUNITY SP LO
�'
1 PROTECTIVE NSPECT
MENT DIV.
ON SEC.
r 1 �
1 = I
CITY HALL FRIDLEn,
I
$5432
NUMBER
REV
71
DATE
FPAGE Of
APPROVED BY
612-571-3
50
910415
6/10/98
/ /
JOB ADDRESS 820 Pandora Dr
ve NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR:
6
5
Brookview Terrace 3rd Addition
SHEET
2 PROPERTY OWNER MAIL
ADDRESS ZIP
PHONE
Harvey Cain 820 Pa
Bora Drive NE
571-1696
3 CONTRACTOR MAIL
ADDRESS ZIP
PHONE LICENSE NO.
Up Top Construction 273
111 Ave NW, Coon Rapids, MN 55433
422-8785 7712
4 ARCHITECT OR DESIGNER MAIL
ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAI
ADDRESS ZIP
PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑
Q
ADDITION ❑ ALTERATION X REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (0
S) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building
Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELEC RICAL, PLUMBING. HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID I WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED F R 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 XAMINED THIS APPLICATION
1
STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORR CT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE F WORK WILL BE COMPLIED
$2,502
$1.25
WITH WHET ED 1EREIN OR NOT. THE GRANTING OF A PERMIT
DOES NO PRESU TO G AU ORITY 0 VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISI S OF OT R STAT O L AW REGULATING CON-
$74.75
Fire SC $2.50
STRUCT ON OR H PE RMA CTION.
PLAN CHECK FEE
TOTALFEE
License SC $5.00
$83.50
SIGN uR C NTRACT RO AUT OR12ED ENT IDATEI
WHEN PROPER ALID TED THIS IS Y/O%L'JR PERMIT
p
®
BL& INSP
GATE
_
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: e'
Legal Description:
Owner Name & Address:
Contractor: V
Address: 22,12
.. /// 7w , -w
Effective 171/98
Tel. #
MN LICENSE # % 7/
Tel. #07
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
Sq. Ft.
GARAGE AREA: Length
Width
Height
Sq. Ft.
DECK AREA: Length
OTHER: ice S
Width
Ate&
Hgt/Ground
:?b
Sq. Ft.
171�&e -fJ�
�-- 0 a o0—
Construction Type: �� /%� Estimated Cost: $
(Fee Schedule on Back) c,? S74;2
Driveway Curb Cut Width Needed:
DATE: / -/ 0, " APPLICANT:
Fel. #
T
STIPULATIONS:
Permit Fee
$ �~
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
$ e3 ��
STIPULATIONS:
Building
Inspections
763-572-3604
DATE // 1' 7 "
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERIMT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR
0 OWNER W(5N-TRACTOR
PHONE:
COMPANY NAME:
CONTACT PERSON: "
STATE LICENSE
PHONE
Ia-SNGLE FAMILY 0 TWO FAMILY
0 NEWPLACEMENT
DETAILED DESCRIPTION OF WORK
EXP DATE
Permit No.:
Received By:
Date Rec'd:
FAX Z_ /rl
0 TOWNHOUSE
0 ALTERATION/REMODEL
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. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) CpZeZ /1 SIZFJBTU�!
Equipment Installed MFG: nmol� MODEL:
SIZE/BTU
MFG: MODEL: SIZEBTU
MFG: MODEL:
,/A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGEIOVEN $10.00
AIR TO AIR EXCHANGEER $15 —FIREPLACE (WOOD) $35.00 NEW GAS $100.000
.
BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR HTR 00
$
CHIMNEY LINER $10.00 —GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00
_GAS PIPING $10.00 _VENTILATOR $1500
ic
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 i of to start without a permit; that the work will be in accordance with the
approved plan in the case of all w hich re and approval ofplaness.. /
SIGNATURE OF APPLICANT PRINT NAME / ` DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
$
Number of fixtures @ $10.00
x $10.00 = $
Permit Fee
Surcharge
DUE
$ .50
$
Number of fixtures @ $15.00
Number of fixtures @ $25.00
x $15.00 = $
x $25.00 = $
TOTAL
e
zc
Number of fixtures @ $35.00
State
x $35.00 = $
Surcharge = $ .50
�® ��
�'��
Total $
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 i of to start without a permit; that the work will be in accordance with the
approved plan in the case of all w hich re and approval ofplaness.. /
SIGNATURE OF APPLICANT PRINT NAME / ` DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
ALL FEES ARE BASED ON VALUA"1-ION, INULUDINU I M UUA 1 ur i.Anvic Allm iviA a c,acxAa.a:
X�SING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION S Cx
V%-%-UrAn%- X i It Jr r.
BUILDING
$
Permit No. In
Building
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By:
763-572-3604
Surcharge
CITY OF FRIDLEY
DatiM MAY 9 2008
763-502-4977 FAX
EFFECTIVE 1-1-08
$5.00 (State Licensed Residential Contractors)
SAC Charge
m ("
DATE 5
YOUR E-MAIL ADDRESS V dJii
c
J (P L" insfl • (®
SITE ADDRESS
ft + 6 ft = ft x $21 =$
Erosion Control
THIS APPLICANT IS: ❑ OWNER QiCONTRACTOR
$450 Conservation Plan Review
PROPERTY OWNER/
NAME: &•v1� CXr` +/ n
Fee Determined by Engineering
Q
ADDRESS: O- G 4:`rtn CITY
FridUt-i STATEIMZIP SS 3, -
TENANT
Total Due
PHONE:
Make checks payable to: City of Fridley Attach Stipulations
NAME: J710 -re,
ADDRESS:, Val`S 1-,S I S'f .S4
CITY -J '-J"LI -61 STATEM1 ZIP S37 I
CONTRACTOR
SUBMIT A COPY OF
PHONE -7(Q ]� - 6 3 3 -/ 00 i FAX
YOUR STATE LICENSE
STATE LICENSE # D / �"
EXP DATE G'
PROPERTY TYPE
INGLE FAMILY/NEW CONSTRUCTION SIZE
- --.. PRINT NAME. %/_'//, ��GaSSE DATES
❑ TWO FAMILY/NEW CONSTRUCTION STORIES I
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: Gtr
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING
AHOUSEONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
,0 HOUSE & GARAGE
I. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used,
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
ADDITIONS. & PORCHES SUBMIT:
❑ Vinyl
❑Soffit
I. Site Plan/Survey showing the existing structures
❑ Aluminum
❑ Trim
and proposed project.
❑ Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUA"1-ION, INULUDINU I M UUA 1 ur i.Anvic Allm iviA a c,acxAa.a:
X�SING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION S Cx
V%-%-UrAn%- X i It Jr r.
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ 49-(J0
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks payable to: City of Fridley Attach Stipulations
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
odes; that I understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work will be in accordance with the
proved pX11'n thecase of all work which requires review and approval of plans. _SIGNATURE
���
OF APP
- --.. PRINT NAME. %/_'//, ��GaSSE DATES
DA3!6/
APPROVED BY