PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn. N? 2929
Date.. . ...... ...
Owner Builder
Address...�'1L?:: Address
LOCATION OF BUILDING
No. ....l.. jt�..... Street ..2!' ...... e�...... Part of Lot ...................
Lot .... 4?�........ Block .. 6........... Addition or Sub -Division
i
Corner Lot ............ Inside Lot ........ Setback 9;r Sideyard .% .. �4:q�
DESCRIPTION OF BUILDING
To be Used as:
Front Depth . �. Height Sq.. Ft. � � Cu. Ft. ........
.................... Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft. ......
Type of Construction,.'/.z:... Est Cost ...el.. .d.. .... 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 village of Fridley.
In consideration of the payment of a fee of $. /2".`. 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 village limits and this permit may be revoked at any time upon violation of of the provisions of said
ordinances.
Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumb -Ing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
s
City ®f Fridley, Minn.
BUILDING PERMIT
July 20, 1965
Date:
Patrick N. Spaeth
Owner: o W.E. Builder
Address Address
same
N? 8243
LOCATION OF BUILDING
131 Panorama N.E.
No. Street Part of Lot
Lot 2 _ Block 6 Addition or Sub-DivisionCarlsons Simmit Manor South Addition
Corner Lot _ Inside Lot Setback Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: attached garage
Front30 Depth 24 Height 10 Sq. Ft. 720 Cu. Ft. 7200
Front Depth H ght Sq. Ft. Cu. Ft.
Type of Construction wood frame Fast. Cost ._ 1,500_ _ To be Completed
New attached garage.
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 sit fprth a9d in�complianc� with a p,Iovisions of
ordinances of the city of Fridley. ! i - —M X /I
In consideration of the payment of a fee of $ S UO , permit is hereby granted tc Z: r Spaeth
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
wn ithi the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
Allen G. Jensen
Building Inspector
NOTICE
Ub permk den net eorer the wndruetion, kdallatien for whin& phmrhtng, on henth , rarer or water. Be sun to me
tla Building mqm for for ssperaM permhe for than Items,
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S mm' /V ej eh BUILDER
LOCATION OF BUILDING
NO. STREET PART OF LOT
LOT BLOCK ADDITION OR SUBDIVISION
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;
a 1 dC ; Front Depth Height /�_
Sq. Ft. °_ Cu. Ft. `7
Front Depth Height
Sq. Ft. Cu. Ft.
Type of ConstructioCjrl /'t`Estimated Cost/lr,/- �460
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.
DATE212 C) jL SIGNATURE
(Schedule of Fee Costs can be found on the Reverse.side).
SUBJECT
P
City of Fridley
2 , 5 7 6
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
NO.
COMMUNITY DEVELOPMENT DIV.
J //
______
r 1 v PROTECTIVE INSPECTION SEC.
�7/
I i
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
I'' 612-571-3450
910-F15
7-13-98
JOB ADDRESS 131 Panorama Avenue
t LEGAL
LOT N0.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
6
lCarlson's Summit Manor South Add. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
Pat Spaet4 131 Panorama Avenue, Fridley, 55432
O
5 2 28
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.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION [X REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Re -roof house & garage (27) sq - tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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. 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
$2'2�c 1
$ 1.13
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
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTA E
$78.13
IG TURE0 ''0 T CTO ORAUTHORIZ NT IDATEI
PR PE OF LIDAT IS IS YOUR PERMIT
BLDG SP
DATE /
SIGNATURE OF OW ERUFO NER BUILDER, IDATEI
NEW [ ]
ADDN [ ]
ALTER [ ]
ConstructionAddress :
Legal Description: _
Owner Name & Addr
Contractor:
Address:.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY .OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Attach to this application, a Certificate of Survey
lot, with the proposed construction drawn on it?c
DESCRIPTION OF R"ROVEMENT
Effective 1/1/98
I
— Tel. # /n�X
LICENSE #
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Construction Type: Estimated Cost: $
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT
Tel.17
Permit Fee
S�
$
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ t3_
$.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 $ c (7. 8
STIPULATIONS:
SUBJEtT
City of Fridley
32233
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
� • _____ COMMUNITY DEVELOPMENT DIV.
!� 5
72®3804
��
r PROTECTIVE INSPECTION SEC.
L = ; "',•� CITY HALL FRIDLEY 55432
NUMBERpEV
DATE
PAGE OF
F/
APPROVED BY
_-_-
L J\ 612-571-3450
910-F15
10/9/01
/
10B ADDRESS 131 Panorama Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
6
1 Carlson's Summit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Pat & Bobbie Spaeth 131 Panorama Ave
NE 763-572-8228
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Wellington Windows 3938 Meadowbrook Rd, St Louis Park, MN 55426 952-933-6300
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
O NEW 0 ADDITION 0 ALTERATION CR REPAIR 0 MOVE 0 REMOVE
B DESCRIBE WORK
Replace Windows Within Existing Openings
9 CHANGE OF USE FROM
TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms
and on all levels of the
dwelling per Section 310.9.1.2 of the 1997
Uniform Building Code. Caulk
and flash all exterior openings.
Permit Inspection Cards
Will Be Mailed
To Homeowner To Post
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING. HEATING,
TYPE OF CONST.
OCCUPANCY 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 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 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
$2.10
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$4,212
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-
$111.25
Fire SC $4.21
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
OTAL FEE
Cityc se
$117.56
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEi
HE PR LY VALID ED THIS IS YOUR PERMIT
SGNATURE OF OWNEROF OWNER BWLDERi tOATEI7BL
G iNSP OAiE
NEW [ l Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLIC9TION
Construction Address: 13(AOM �t< trJp
Legal Description:
Owner Name & Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
5SYPV
Attach to this application, a Certificate of Survey of the.
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length . Width Hgt/Ground
Sq. Ft
/ ff\\ Gd
Construction Type: Lr,c �n Estimated Cost: $ Id.
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. # QST
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ ?5 Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $.50/$1,000 Valuation
SAC Charge $ _ $1100 per SAC Unit
License Surcharge $ �;sed-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 [ J Not Necessary [ ]
�6
TOTAL $ I 1 1
STIPULATIONS:���77a- . eZ
SUBJECT
City of Fridley
12�630
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
`COMMUNITY DEVELOPMENT DIV.
v______
r i PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE Of
APPROVED 9Y
L J\ 612-571-3450
910415
5/24/02
JOB ADDRESS 131 Panorama Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
2
6
Carlson's Summit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Patrick Spaeth 131 Panorama Avenue NE 763-572-8228
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Renewal By Andersen XXX 1920 Co Rd C W Roseville MN 55113 651-264-4777
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
20130983
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
Replace 10 windows within existing openings
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code.
Permit Inspection Cards
Will Be Mailed
Th Hnm,m Wner To Post
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
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
$7,305
$3.65
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
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$153.25
Fire SC $7.31
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTALFEE
$V4.21
SIGNATURE OF CONTRACTOROR AUTHORIZED AGENT IDATEI
EN FAOP ALIDA D MIS IS YOUR PERM17
�� rV
SIGNATURE OF OWNERIIF OWNER BUILOERI IDATEI
BLQ6.NSP - - GATE
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTS [ l SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address--"? ..CY.- SP4.1e� � ' Tel. #mag. I ,a "',
Contractor:; C&' -iku MN LICENSE # x01309
Address: 19 a o cz�6n� -;,ao a c. w,e -V; ,s tk.,mn� Tel. # ((pSl • alo4.4 1•�-
Attach td this application, a'C;ertificate` of Survey. of -the
lot, with the:proposed constructiondrawn_.fln-it to scale.
DES.CRUM- ON bil? ", A0VE 1ENT.
LIVING AREA: Length Width
GARAGE AREA: Length Width
DECK AREA: Length Width
OTHER: n � e .
Construction Type:
Driveway Curb Cut Width Needed: Ft. + b Ft =
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
11 . I
Estimated Cost: $ �fDCR00
Ft x $
DATE: .0 APPLICANT: �•,p� Tel. #Q�Sa •34,5 • (Mq -
CITY USE ONLY
Permit Fee Fee Schedule on Reverse Side
Fire Surcharge .001 of Permit Valuation (1/10th%)
State Surcharge $ 3 . Lo Ej $.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 [ ]
TOTAL $ 6 • L
STIPULATIONS:
SUBJECTIWE-RbM
City of Fridley
33639
AT THE TOP OF THE TWINS
BUILDING PERMIT
�
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r � � PROTECTIVE
L � CITY HALL FRIDLEY 554$2
1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
..•.
L J` 763-571-3450
9
6/25/03
JOB ADDRESS 131 Panorama Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
6
Carlson°s Summit Manor South Addn SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Pat/Roberta Spaeth 131 Panorama Avenue NE
J CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Home Improvements of MN 13789 Fordham Ct, Apple Valley, MN 55124 612-598-9554
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
20184826
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
Reside House; trim
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive
barrier be placed over exterior sheath'-?g to protect the interior wall covering.
Exceptions for this provision would be if sheathing is an approved weatherproof
panel or when the siding is an approved weather barrier. Vinyl siding is not
a weatherproof covering unless the manufacturer states this in their application
guidelines. Call for inspection of wrap before covering or take pictures. Caulk
and flash all exterior openings.
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 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 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
@
$9,000
$4.50
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
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$167.25
Fire SC $9.00
STR CTION OR T E PERFORMAN OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
Lice se SC $5.00
$185.75 ..
NATU E OF C N'AACTOR OR AUTHORIZED AGENT ,DATE,
HEN PROPERLY VALIDATED THIS IS Y04R PERMfr
SIGNATURE OF OWNER,6 OWNER BUILDER, (DATE,
1NSP T1A�E
NEW [ ] CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & A(
Contractor.
LIVING AREA:
GARAGE AREA:
Tel. #
MN LICENSE # d'c '-2Ol9 '0'26
Tel. # 6-/2, v�`i8`–�'s
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
DECK AREA: Length
OTHER:
Width Hgt/Ground Sq. Ft.
Construction Type: Estimated Cost: $ ��®y
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
DATE: 6–A�--U_3 APPLICANT: %y 177al1Ul z-- Tel. # 4 I'L s � !orf
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 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
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ �r Fee Schedule on Reverse Side
$ /i. �® .001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$ $1275 per SAC Unit
$ . C $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 [ ]
$ C -� • !1-5' STIPULATIONS,