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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 3602 Date: . /� ..... �.. ...®.. ....... Owner ....................................... Builder .................................. Address...................................... Address ........................................... �J LOCATION OF BUILDING No. P. Street .. .... n .... ............. Part of Lot .. . Lot ..,1...... Block ...... Addition or Sub -Division Corner Lot ............ Inside Lot . X......... Setback,.1�..� Sldeyard .�7...® ...... ..'41' DESCRIPTION OF BUILDING TO Us � .. Front . 7.° . Depth: Height /Y.7.51 Sq. Ft. /0f! . Cu. Ft. -70:7 o� Front 7 Depth P� :. Height . . e� Sq. Ft. ..1.. Cu. Ft. 3 i!Y 0 _`� eU Type of Cc ction ................... ]het. Cost..�•l`.��J�.. �. To be Completed ................... �� In consideration of the issuance to me of a permit to construct the building desribed above, I agree. to do the proposed work in accordance with the description above set forth and mi mpliance with provisions of ordinances of the city of Fridley. A' ..... 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 regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the catty limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. 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 Application for Plumbing and Gas Pitying Permit DESCRIPTION OF WORK Number, Kind. and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures..... ................. x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ �U' (D V' z % x 2.00 $� WATER HTR. x 3.25 $ 4- 3 CJ 1st 3 Fixtures .......................... m $ /-.15�® H 3 O m LL U 6 3 Q C�? 4a (�9 O F N GAS ELEG t� Base 1st 2nd 3rd 4th a Future Connection Openings Connected with New Fixture, Old OpeningsSewer I Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures..... ................. x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... % x 2.00 $� New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... X x $1.50 $ /-.15�® Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE 0j -1 -D-0 r6� II Dep:. of Bldgs. Phone SU 4-7470 Location � % / 0 Pld" Z� a, 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, 1Vlinn YAI' �� 1wo Owner 7) ��' =b" d �i11 19— Kind of Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. C� Signed Business Phone No Connection Permit No . ....................................................... g � Water Sewer 11 IM -8-58 Meter Deposit MINDERENGINEERING CO.,INC. ENGINEERS AND SURVEYORS LAND SURVEYING SOILS TESTING CIVIL &. MUNICIPAL ENGINEERING LPr,4D PLANNING 6418—S6*rw AVENUE N. MINNEAPOLIS 'ZT,MINN. KE -t- SG37 iroti <J WE HEREBY CERTIFY THAT THIS 15 ATRuE AND CORRECT REPRESENTATION,OF N 5UIZYEY OF THE BOUNDARIES OF THE LAND NBOVE.DE5CIZIBED AND Or -THE LOCATION OF ALL BUILDINGS, IF ANY, THEREON, ARID ALL VISIBLE ENCROACHMENTS. IF ANY, FROM OR ON SAID LAND. MINDER ENGINEERING CO,, INC- CINTED THIS OW OF 7 ENGINEERS Nmr) SURVEYORS by An Amacafta fbF Powor R ead, Hea' n a vm. ®i ®s Aly ''d` $= cmd Dow1cm PARTIAL RATE SCHEDULE Dapt. of mava. none Mvm- GRAVITY WARM AIR: Ic�A TOTAL Furnace Shell & Duct Worts ... ... . $10.00 $ Replacement o4 Furnace . 6.00 S — City of Fridley: Repairs & Alterations—up to $500.00d � � The undersigned hereby makes application for a permit for the work here & specified, agreeing to .do all work in strict accordance with the City Ordinaneev Repairs & Alterations each add. $500.00 3 W $ and ruling of the Department of Buildings, and hereby declares that all the fac and representations stated in this.applicaUon are true and correct. )Fridley, Mnn Furnace Shell & Duct Worts to 120,000 BTU ..$10.00 � each add. 00,000 BW . ......... 3.110 g Owner Replacement of Furnace &00 ®® Kind of Building Repairs & Alterations—up to $800.00 6.00 $ • . Repairs & Alterations each add. $500.00 3.00 $ Used as - To be completed about SSTEAMoa HOT WATER STS' , _ � - Furnace Shell do Lines—to 400 sq. ft. FZR Steam $10.00 $ Estimated Cost:, $ 3_' Furnace Shell &Line --to 640 sq. ft. EDR Hot Water 20.E $. Old-- ew. 'Building Permit No. _ __ permit No. Each add 200 sq. ft, EDR Steam Each add. 320 sq. ft. EDR Hot Water 3.00 $ DZECRUPTION or WOR OIL BURNER—to 3 gal per hour 6.00 g over 3 gal. per hour—See Fee Schedule GAS SUR Cup to 19g, BTU) 6.011 $ � over 199,000 Irm See roe Schedule GAS FITTING : NO RATE 'L'O'YAL 1st 3 Fixtures x$ 200 g___ ® Additional Fixtures x .75 Gas Lange to M.M x$ 6.00~ 3 --I- ? ®i(_ State Surcharge .50 8 law Fee sd HEA77NG or POWER PLANTS—Steam, Hot Wates, wren Air—Pio Trade Name e�� Size NO Capacity—_—• - — Sq. rL E.D.R BTU XJ[W_" Total Connected Load Kind of Fluel BURNER — Tnxk N 6 size Flo-� 0 0 C� capacity An Fit. f s f t�� f { 77, 1 SUBJECT City of Fridley rj$- AT THE TOP OF THE TWINS g U I L D I N G PERMIT r � RECE O. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 0 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/25/83 JOB ADDRESS Gary Pederson 6710 Plaza Curve N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. S1 21 3 Rice Creek Plaza South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Pederson 6710 Plaza Curve N.E. 571-0202 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING patio 7 CLASS OF WORK ❑ NEW X7 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Roof patioK 15' x 16' 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. rglasq THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 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 500.00 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 SRC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE lei 15.50 ATURE OF CONT A To 0 UTH RIZED AGENT (DATE) N PROPERI& VALI ED THIS IS YOUR MI SIGNATURE OWNER OF OWNER BUILDER) IDATEI - BLDG WSP GATE 1 CITY OT FRIDLEY Effective Aug. 1, 1981 APPLICATION FOR RESIDENTIAL BUILDING PERPUTS (HEm. Alterations. Additions, or Repairs) OWNER: e4�� Zevj ADDRESS: a ave.- TEL v� TEL 110: _ J22;% --001.0 ,;Z._... • STRITT NO: STREET: LOT: BLOCK: 6UI LDER : ADDRESS: TEL 110: Construction Location ADDITION: Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this fora two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION ��710Front: Depth: Height: Square Feets Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: 0 'type of Construction: yt./�� p_ CV CEstimated Cost: S ®. '!b Be Clompleted:T- ti Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: SEE REVERSE SIDE OF SHEET Zine undersigned hereby makes application for a permit for the Mork herein specified, agreeing to do.all Work in strict accordance with the City of Fridley Ordinances and rulings of the Delvlrtment of Buildings, andeby declares that all the facts and representations stated in this applicatio a true and r ec DATE: /� " SIGNATURE: Stipulations W -ro U -*)w -r-, it ry)al C con,jcexii- +c) O -How Curve, fk,. l4f- r/- -+he, 3 -ft, 61clit,. lot to the, propert',�, Se -P+ -ern b er 17 , 19 91 vtl (21 i 9 h b6 K) w i ce) go cLAo�ci li� lirn"-it- UP Idt, lot IIK)CI E SUBJECT MIT NO. City of Fridley 2-1703 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT N0. � • COMMUNITY DEVELOPMENT DIV. r I L PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 1/6/93 10B ADDRESS 6710 Plaza Curve NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 21 3 Rice Creek Plaza South SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Gary Pederson 6710 Plaza Curve NE 571-0202 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Budget Exteriors 501 16th Ave, Newport MN 55055 458^5531 6564 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 [j REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace windows 9 CHANGEOFUSEFROM TO STIPULATIONS 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 MOT. 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 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 $5,250 $2,63 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- $81.00 Fire SC $5,25 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $93,88 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI ENR RL V LID ED THIS 1$ YOUR PERMIT BLDG WSp DATE SIGNATURE OF OWNERdF OWNER BUILDERI IDATEI `' E NEW [ ] - Effective 3/1192 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner l Contracts Address: Tel. # Eji I - QW-)_ MN LICENSE # __Tel. # 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 GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: Sq. Ft. Sq. Ft. Sq. Ft. Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $�® Approx. Completion Date: r � Z-ok Gds Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ (Cost on Back) DATE: APPLICANT:Tel. # tj Gq ® C TY USE ONLY r Permit Fee $ g ee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1 / 10th %) State Surcharge®r $.50/$1,000 Valuation SAC Charge $ $700 per SAC Unit License Surcharge $ 00 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee. Determined by Engineering Sewer Main Charge $ Agreement Necessary j ] Not Necessary STIPULATIONS: BUJLDING INSPECTION DIVISION MEMO MEMO TO: GARY PEDERSON, 6710 Plaza Curve NE Nt) MEMO FROM: CLYDE W.EY, Acting Building Official MEMO DATE: March 22, 1993 REGARDING: Window installation at 6710 Plaza. Curve NE by Budget Exteriors The installation of the windows at your address does not meet egress code requirements for the following reasons: 1. The egress opening of the bedroom windows was made smaller by the installation and is less than that required in Section 1204 of the Uniform Building Code. 2. The area around the installed units must be sealed to stop air infiltration as noted in Section 502.4.3 of the Energy Code. suB�EerjkAUff NO. City of Fridley 29711 AT THE TOP OF THE TWINS BUILDING PERMIT f RE O. COMMUNITY DEVELOPMENT DIV./J7�//�/�}�( PROTECTIVE INSPECTION SEC. R NUMBER REV DATE PAGE OF APPROVED BY 1 i 0.1 -6 CITY HALL FRIDLEY 55432 ,'J 612-571-3450 910415 6/17/99 e JOB ADoaess 6710 Plaza kXXXXIN 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 21 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary D Pederson - 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 O ALTERATION X REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reside house and garage 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. SEPARATE PERMITS ARE REQUIRED 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 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 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 $1500 $.75 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. p $'554.00 $1.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION Fire SC PLAN CHECK FEE TOTAL FEE $56.25 t_U�U EEOOFF CON'RACTOR OR AUTHORIZED AGENT iDATE. WHEN PROPE VALIDATED THIS IS YOUR PERMIT �A S.G ATURE OF OWNEROF OWNER SUROER3 15ATEi LOG INSP r)AIt NEW [ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Z/—o 0, u ( \/, L Z),' 3-791 Legal Description: Owner Name & Address: �/ j�, '�� e --so PL) Tel. # 6 l --5--2j - d a � Contractor: S @ i 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 Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: P'q �,) 11'n I j< P kL Q n V n, o Construction Type:_ ` yp (�Estimated Cost: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: (v APPLICANT: �E;��GE Tel. #G/o— STIPULATIONS: CITY USE ONLY Permit Fee $L`�D Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ �� $.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 $� STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 FAX: ( 763) 571-1287 ADDRESS : 6810 PLAZA CRV NE PIN : 143024230034 LEGAL DESC : RICE CREEK PLAZA SOUTH ADD : LOT 11 BLOCK 3 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMI NO.- 2004-01083 DATE ISSUED: 07/12/2004 VALUATION : $ 500.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. REPAIR EXTERIOR WALL FRAMING. STATE LICENSED CONTRACTOR 1 APPLICANT TIMBERCRAFT ENTERPRISES INC (2624) 388 CLEVELAND AVE SW NEW BRIGHTON, MN 55112 (651)633-8611 OWNER STASIK LORI L 6810 PLAZA CRV NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law g construction or the performance of construction. Applica Date Bldg Dates/l L� BUILDING PERMIT FEE 23.50 FIRE SURCHARGE 0.50 STATE SURCHARGE, VALUE 0.50 LICENSE SURCHARGE 5.00 TOTAL 29.50 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. k44 �� b NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTERSINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: / 67 reams Legal Description: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: # u3 - �9/- FC/® F :NSE# 2/o z Y Tel. #y'J-1 ` 6 - J'( // 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. Construction Type: ✓�l' L/ AliitjcZ4 /I �r stimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 7`1 01 APPLICANT: 4,114 T.4We-- Tel.# C"/i PoM(owe k Call (763) 572-3604 for Permit Fees if ma' ng in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ c;4f 56 Fee Schedule on Reverse Side Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ —®� 65% of Permit Fee $ m SU .001 of Permit Valuation (1/10th%) $ "S-6 $.50/$1,000 Valuation $ $1350 per SAC Unit $ <do $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 [ J $ •S� STIPULATIONS: