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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N° 6573 Date: stat-= Owner: 4z Builder ee& Address Address LOCATIOB ILDING No. Street L aLAM- Part A Lot Lot__ Block Addition or Sub-Division� _ Corner Lot . _ Inside Lot _ _ d°!:ff Setback - _ _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING T Used Front Depth Height : Sq. Ft. Cu. Ft4gg& t Depth Height �Sq. Ft. Cu. Ft. Type of Construction Est. �4�°o 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 jpvith all provisions of ordinances of the city of Fridley. I/). Q _ , Y 19 v 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 location, construction, alteration, maintenance, repair and moving of buildings within the city limits andel this permit may be revoked at any upon ordinances. /1 �1 / violat'rgn of any of the provisions of said NOTICE: Me permit doss not corer the construction, brstallation for wbdng, plumbing, gea heating, ower or water. Be are to as the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA CWWR'S NAME BUILDER ADDUSS ADDRESS No. LOCATION OF BUILDING 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 build- ing location drawn on these Certificates. To be used as; DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq, Ft. Cu. Ft. 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 Departm-.nt of Buildings, and hereby declares that all the facts and representations stated in this application Ire true and correct. DATE SIGNATURE �c (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 ........................... 8.00 $ Replacement of Furnace 5.00 $ Repairs & Alterations—up to $500.00 ................ 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. Per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ is GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures . ............... x .50 $ Gas Range to 200,000 BTU .......... , x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $�D ROUGH FINAL Dept. of Bldgs. Phone SU 4-7470 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, Owner Kind of Building Used as To be completed about )4 Estimated Cost, $ _=-New. Building Permit No. �/ permit No. DESCRIPTION OF WORK 19 4!�3 HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Named Size No & Capacity �Sqq.' Ft. E.D.R g BTU H.P. Total Connected Load /��� / Kind of Fuel BURNER — Trade Name Size No Capacity. (REMARKS -OVER) MQW 42 SII Sq. Ft. E.D.R BTU H.P. SUQUR,M HEATING & SHEET METAL 8419 r.3274TER BIVE JUS 32 �.. a•�rr��� Signet s e By Business Phone No Windows and Doors—Crackage and Area l Width Height No. of Lineal ft. Area No. of pane of pane Ifghts of crack sq. ft. ,LOSS a- 10,4 2' S-9 ®9m rj vP 9, �! HEAT CALCULATIONS DEPARTMENT OF LILDINGS FRIDLEY, MINN. Weatherstrips Glass A- Euii .E. Guide g'$ Construction No. Insulation Windows I Doors Reference Out. Wall Jlnt.Wall I Ceiling Roof Floor Kind How Applied ° Yes—No Yes—No Ceiling 19_ d o Floor F1.1 1.,4 Room I Lenstth /A, Width `A Heistht II / Fl .l 14 ith / q Width '3-9 Height 7 Windows and Doors—Crackage and Area l Width Height No. of Lineal ft. Area No. of pane of pane Ifghts of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. a- 10,4 2' S-9 ®9m rj vP 9, �! ®�® Coef. Btu Infiltration ®, .20 Glass Glass g'$ Exp. wall Exp. wall Glass Net exp. wall Net exp. wall �;L 6'9 , Int. wall Net exp. wall Ceiling Ceiling 7 el 10/ d o Floor 0 total Btu. 1 5'7 q9. V Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I F1.I AA1 Room I Length i7 Width A2. a Height Windows and Doors--Crackage and Area cy 1/1Y Width Height No. of Lineal ft. Area No. of pane of pane Ifghts of crack sq. ft. d ®� e I E- to 3 2' S-9 ®9m rj vP 9, �! ®�® Coef.1 Btu Infiltration Btu 20 Glass 2-6 Exp. wall /Q Glass Net exp. wall Exp. wall Int. wall Exp. wall Net exp. wall Ceiling P 7 el 10/ Floor 1 otal Btu. I &? 2,,, g Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Room I Length 1A Width f'� o_A Height V Windows and Doors—Crackage and Area cy 1/1Y t' Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. I E- to 3 2' S-9 ®9m rj vP 9, �! ®�® Int • Coef.1 Btu Infiltration S' 2-6 Glass 0 Glass Glass, Exp. wall 9 A.F� Exp. wall Net exp. wall i /01 7 el 10/ Int. wall 0 Ceiling Int. wall 39-1.4116 6 Floor Int. wall Ceiling Tbtal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area cy 1/1Y Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sqft- Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. I E- to 3 2' S-9 ®9m rj vP 9, �! ®�® Int • el. / Coef. Btu Infiltration 0 Glass Glass, ,� A ✓� 9 A.F� Exp. wall (s -. e Net exp. wall 0 Int. wall 39-1.4116 6 P e Int. wall Ceiling 62 9 Id 6 tel Floor a Total Btu. S 21. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / Fl.l S-/iJ ZN Room I Lenstth x'e Width /</ Height Y Windows and Doors—Crackage and Area cy 1/1Y Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sqft- l�P mid I E- to 3 2' S-9 ®9m rj vP 9, �! ®�® Int • el. / Coef. Btu Infiltration Pei 1261/ Glass, 07.4 Ise (s Exp. wall P 901 Net exp. wall 39-1.4116 6 P e Int. wall Ceiling a Floor — Total Btu. Required sq. ft. E.D.R. or sq. iris. W.A. leader area / FLI XVe I ., 4:.',..:.Room I Length 2 S- Width 2 d Height Windows and Doors—Crackage and Area o .�� Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. l�P mid I E- to 3 2' S-9 ®9m rj vP 9, �! ®�® Int • el. / Coef. Btu %Infiltr 1261/ Glass 07.4 Ise 11510t Exp. wall P 901 Net exp. wall 6 / F t/ Int. wall Ceiling Sme--e) Floor — Total Btu. Required sq. ft. E.D.R. or so. ins. WA. Leader arra a D S6 a z HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS .Weatherstrips A.S.H.V.E. Construction No. Guide WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Yes—No Yes—No 19_ Fl -1 I Room I Length ® Width /.7— Height k II F1.1 Windows and Doors—Crackage and Area 2— / Y Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. ' Coef. Btu Infiltration Coef. Btu Infiltration Net exp. wall 26 16,10 Glass Ceiling Floor Exp. wall r2— Net exp. wall Int. wall Ceiling .a�� 9� �t po Floor 1 otal Btu. I I/ Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Leneth Width Heistht Windows and Doors—Crackage and Area Width Height No. of Lineal [t. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor 1 otal 13tu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane • lights of crack eq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Tbtal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FRIDLEY, MINN. Insulation r Kind How Applied Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. M Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area F1.1 Room I Lenstth ' Width Heistht Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Inc. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area I F1.1 Room I Lenath Width Heiaht Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area I F— City of Fridley Application for Plumbing and Gas F*Nng Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location7 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TqTAL Number Fixtures G x $1.50 $ ` U Future Fixture Opening —Lx 1.20 $� New Fixture Old Opening .............. x 1.00 $ Catch Basin .... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ......�C x 2.00 $ - o New Ground Run Old Bldg. ............ / x 3.25 $ GAS FITTING FEES: NO. RATE TOTALa 1st 3 Fixtures ..........................Zx $1.50 $--,I-L —S Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ G City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this applicatio are true and correct. l �, /7 FridleyQ Minn- � 19 Owner f:7 Kind of Building Used as To be completed about Estimate ost, $ Old— ew. ding Permit ROUGH FINAL 0 By—I.A—el— Business Phone 12� Z Z � Z Z Mw G Z W ? 0 • P • N WATER HTR. GAS ELEG Base 1st 2nd 3rd 4th • Future Connection Openings e New Fixture, Old Openings I Connected with Sewer Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TqTAL Number Fixtures G x $1.50 $ ` U Future Fixture Opening —Lx 1.20 $� New Fixture Old Opening .............. x 1.00 $ Catch Basin .... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ......�C x 2.00 $ - o New Ground Run Old Bldg. ............ / x 3.25 $ GAS FITTING FEES: NO. RATE TOTALa 1st 3 Fixtures ..........................Zx $1.50 $--,I-L —S Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ G City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this applicatio are true and correct. l �, /7 FridleyQ Minn- � 19 Owner f:7 Kind of Building Used as To be completed about Estimate ost, $ Old— ew. ding Permit ROUGH FINAL 0 By—I.A—el— Business Phone UNOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 October 31, 1990 Owner/Occupant 7844 Pearson Way N.E. Fridley, MN 55432 RE: Monument Sign at East River Road/Pearson Way N.E. Dear Owner/Occupant: The monument sign located at the above referenced intersection has experienced substantial deterioration and is in poor condition. I have been unable to locate anyone who could be held responsible for the maintenance of this sign. This monument sign, which is located within the City right-of-way, has become an eyesore and it also constitutes a health and safety hazard. The City is currently considering removing the monument sign from this location for the reasons cited previously. Please contact me at 572-3595 on or before November 20, 1990, if you have concerns regarding this possible action, so that these may be taken into consideration. Sincerely, Steven Barg Planning Assistant SB:ls C-90-946 OF su9�EtT PE City of Fridley 2 967 4 AT THE TOP OF THE TWINS BUILDING PERMIT r RE O. • _ COMMUNITY DEVELOPMENT DIV. � INSPECTION SEC. r � , PROTECTIVE I , , CITY HALL FRIDLEY 55432 NUMBERREV DATE PAGE OF APPROVED BY 612-571-3450 91 -FIs 6/11/99 10B ADDRESS 7844 Pearson Way NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 3 6 Pearson's Craiqway Estates 2nd Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Pawlszyn 571-2334 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Westurn Cedar 9700 13th Ave N P1 Mouth MN 55441 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 O NEW ❑ ADDITION O ALTERATION ®X REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 28 Sq Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 S0. 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 ISTALLS 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 $2447 $1.22 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTI N OR THE PERFORMANCE OF CONSTRUCTION $83.25 j Fire SC $2.45 PLAN CHECK F TOTA EE Y Licen S $5. 0 $9,1/.92 S,GN uRE OF CON'RACTO.OReTHOR11ID AGENT I ATEI EN PR VALIDA D IS IS Y PE50 T Bl G INSo / I nar SIGNATURE Of OW NER nt OWNER BwIDERi [DATE, OF NEW [ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: WTel. # 5 7b 2339 Contractor: Ci MN LICENSE # .?.At Address: I?7on f�� h V� N ?-JYA(4M Ana Tel. # 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: I. En- tth OTHER: DESCRIPTION OF EM PROVEMENT Width Height Width Height Width Izt/Gi Sq. Ft. Sq. Ft. Sq. Ftp_ L'/ '/ 4 Construction Type: Q Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ TOTAL $ l 9,;2 STIPULATIONS: 0-9 X Fee Schedule on Reverse Side Fire Surcharge $ S .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ - 60 $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 $ l 9,;2 STIPULATIONS: e SUBJECT -- O. City of Fridley f31635 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE 1 � � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 9t0 -F15 1/29/01 JOB ADDRESS 7844 Pearson Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 3 6 Pearson's Craigway Estates 2nd Addn SHEET 2 PROPERTY OWNER MAIL ADDRESS, ZIP PHONE Paul/Susan MacDonald 7844 Pearson Way NE 763-571-2215 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sun Design 1066 Circle Dr E, Wayzata, MN 55391 952-476-8297 20225805 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 Construct a 21'8" x 7' Addition and a 21'8" x 7' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNING SEPARATE PERMIT Before digging call for all utility locations REQUIRED FOR: 454-0002 �SIGim PLUMBING AN REQUIRE® BY LAVVIma 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 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 $22,000 $11.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMET GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY HER STATE OR LOCAL LAW REGULATING CON* $349.25 Fire C $22.00 STRUCTIO T E ORMANCE OF CONSTRUCTION PLAN CHECK FE TOTAL EE Licen S $5.0 $ 87.25 SIGNATURE CON TRACTOR OR AUTHORIZED AGENT IDATEI N LIDAT T IS IS Y R PERMIT e BL INS TIATE SIGNATURE OF OWNER,IF OWNER BUILDER, IDATEI e �e3 NEW [ ] Effective 1112000 ADDN CITY OF FRIDLEY (763) 572.3604 Bldg Imp ALTER [ j SINGLE FAMLY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: aij W E e lL Owner Name 8. Address: ry l Tel. L4,3� IS 7 1 - ZZJ 29 Contractor: Address: Ibl LA�bAV6 i1 .x.14- �'I 9 Tei. # % ®��z� Attach to this application, a Certificate of Survey of th� lot, with the proposed construction drawn on 4 to scales, '��� '�✓✓�� DESCRIPTION OF IMPROVEMENT LNG AREA: Length ` Width Height LIVINGP � '� if Sq. fL I GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length l Width f;'� a" HgVGmund 2i ' ° Sq. Ft OTHER: Construction Type: LIT)a) 1W tiDKID" Estimated Cost: $ ZZ, I i/L�)C) Driveway Curb Cut Width Needed: F + Ft = x $ = $ DATE, APPLICANT: Tel. # JgI 7,\ -37Z6 -L5-2,6> CITY USE ONLY - Call (763) 5723604 for Permit Fees if mailing in application Permit Fee $ 3119.Fee Schedule on Reverse Side Fire Surcharge $ as �C� .001 of Permit Valuation (1/10th%) State Surcharge $ / $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $ 6, EC) $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. W or Alt. 'B" Above Erosion Control $ $450.00 Conservation Pian Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary ( ] TOTAL $ 3 a 2. a5 - STIPULATIONS. ?-0/10'Cl z2zT9LdZS6 0i A3-iQ I dj 30 Al I J wodi 0£ : T T 0002-10-33a