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PRE 2010 DOCSCity of Fridley, 1'� 962 BUILDING PERMIT�1� Date: March 5, 1968 Owner: H W. Miller Builder Riley Construction Address 6170 Rainbow Drive Address 2744 Lyndale Ave. S. LOCATION OF BUILDING No. 6170 Street Rainbow Drive Part of Lot Lot _.._..1 Block 3 — Addition or Sub -Division . Sylvan Hills, Plat 2 Corner Lot —_ Inside Lot _ Setback —_ Sideyard — Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft Front Depth _ _ Height Sq. Ft. Cu. Ft Type of Construction Panel Basement Est Cost _000.00 .__To be Completed Remove & Replace kitchen cabinents In consideration of the issuance to me of a permit to construct the build' g described4bove, I q9ree to do the proposed work in accordance with the description ab and c mal ons of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 12.00 , permit is hereby granted to Riley Const. 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 oW of the provisions of said ordinances. -,-', .-1/ NOTICE: Sh permit does not cover the construction, butallation for wiring, plumbing, gas heating, sower or water. Be core to no the Building Inspector for separate pormits for these herrn. APPLICATION FOR BUILDING PERMIT CITY OF.FRIDLEY6 MINNESOTA /����p1f ���y�+ BM �o - a OWNF.R�S;}[c+aau Q _$:2b;DdiR ADDRESS 44.( G� TWCATION OF. BVI. LDING NO. STREET All LOTT LOCK_ _ ADDITION. OR, SUBDIVISION COPWER LOT INSIDE LOT SETBACK � _TSIMARD .., _ SEWER ELEVATION TOP OF FOOTING Applicant attach to this. form ;Two Certificaes of Survey. of.;Lot.:and proposed building location di arra on. these Certificates. DE OF BUILDING To Be Used"": Front _ Dph Height Square feet, . : Cubic;.Feet Front Depth.. Height �S uar et Cubic Feet Type of oastruc o aced Cos, ®d am To Be Completed®10 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 represqpZqtai stn dint applic,tion are true and correct. DATE , _SIGNAT (Schedule of Fee Costs can be found on the Reverse Side). 9 City of Fridley, Minn. 11556 6431 University Ave. N. Ein ., Mneapolis, Minn. 5543C - G PERMIT 3Datq; July 24, 1972 Owner; Builder Quality Const Co ,Address _ Rainbow Drive N.E. Address 2001 East 24th Striet �,176 LOCATION OF BUILDING No - Street Rainbow Drimp N.E. ___- Part of Lot Lot 1 Block _3 Addition or Sub -Division . Sylvan Hills Addition Corner Lot Inside Lot X Setback Sideyard Sewer Elevation Foundation Elevation .: 1111 1 IF • r. To be Used as: Reside House and put stone on front Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. TP pe of Construction _ Vinyl Est. Cost _�1, 000 00 To be Completed 1 week Stipulation: Caulk required around all doors and windows and openings In consideration of the issuance to me of a permit to construct the building described above, I agree to do ft Proposed work in accordance with the description above set forth and in compliance with all provisions of Ordinances of the city of Fridley. 141 1 - I. ,—\ In consideration of the payment of a fee of S 6__0n_, , permit is hereby granted to Quality Const. Co to construct the building or addition as described. above. This permit is granted up= the express condition that the person to whom it is granted and his agents, employees and workmen, in all worts 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 emceecity limits and this permit may be revoked at any time upon violation of any of the provisions of said NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see 1be Building Inspector for separate permits for these items. a' APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWMMIS NAME: BUILDER: a ( �. ADDRESS: % �G�z�m'� 1i1. ADDRESS: NO;. (o/ 20 STREET: .,,A. LOT; / BLOCK: 3 ADDITION: �t CORNER LOT: INSIDE LOT: -SETBACK: SIDEXARDt 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: -"f')Fr t. Depth: Height: Square Feet: Cubic Feet: Front: —Depth: Height; Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $ 16106 e dla9�m'�P'AR,A9 To Be Completed: The undersigned hereby makes application for a permit for the.w4rk 'herein specified, agreeing to do all work in sttict accordance with the City pf Fridley Ordinances and rulings of the Department of Buildings, and 'hereby declares that all the facts and representations stated in this app1j94t&9n are true and correct. lhATS:21^ SIGNATURE: a (See Revers Side For Additional Information.) 6. S -D SUBJECT P City of Fridley 1671 AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIPT N � `y _ COMMUNITY DEVELOPMENT DIV. 7/07 7 r PROTECTIVE INSPECTION SEC. 1 � � CITY HALL FRIDLEY 55432 NUMBER REV. DATE, PAGE OF APPROVED BY L J \ 612-571-3450 910-F15 8/9/82 JOB ADDRESS 6170 Rainbow Dr. N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 Sylvan Hills Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Harry Miller 6170 Rainbow Dr. N.E. Fridley 55432 571-1695 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Milton L. Johnson Co. 2513 Central Ave. N.E. Mpls. 781-9548 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 g ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Install Aluminum soffit and fascia 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. Aluminum 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 R-1 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 $1,000.00 $.50 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- S RU TION OR THE PERFORMANCE Qf CONSTRUCTION. $17.50 PLAN CHECK FEE TOTAL FEE $18.00 SIGN TUREOFCONTRACTOR CVNIORIZEDAGENT (ATE) -J. WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER] (DATE) CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDtNTIAL BUILDING PE•R19ITS (New, Alterations, Additioni, or Repairs) OWNER: itk ADDRESS: 6 -70 a TEL NO: YP BUILDER: ADDRESS: C��i��� Au,AJE: TEL NO: ? ?/ 7 9 y P Construction Location - STREST NO: 7 STREET: l` /i o� %`✓ �' IAT: BLOCK: ADDITION: Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: Height: Square.Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cabic Feet: Rype of Construction: Al u rk V 4b Be Completed: Proposed Driveway Width If New Opening Is Desired: Estimated Costs Alt. A Alt. B SEE REVERSE SID£ OF SHEET Rile undersigned hereby makes application for a permit for the %2ork*herein specified, agreeing to do -all work in strict accordance with the City of Fridley Ordinances and rulings of the Delwirtment of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: � ' Cl - � � SIGNATURE: �_—�� Stipulations: STATE 'OF HINNESOTAREPA _, , , T. WEL 1. LOCATION OF WELL I County Raw t1 n o l,, a j `Q Township Name Township Number Range Number Section Fracti Fridley N E or or S W Numerical Street Address and City of Well location or Distance from Road Intersection 6170 Rainbow Drive Fridley, !-Zn. 55432 W Slow exact location of well (in section grid with •X') M MENE 5. DRILLING METHOD (if known) ME 413 Reverse 713 Driven IcO Dug MEME 5Q Air go Bored II❑ ON 60 Jetted 9❑ Power Auger a ►�� 1 ■i Ze 2. PROPERTY OWNER'S NAME testate of Harry Miller E 1 Sketch up of well location Mailing Address if different than property address indicated above Same HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM If not known, indicate formation log from new well or nearby well. OF HEALTH MINNESOTA UNIQUE WELL NO. (leave blank if not known) alp'4. WELL DEPTH (completed) Date sealed of +� 35 ft. 1/1'3/90 S. CASING(S) 1® Black 40 Threaded 70 213 Gals. 50 Welded 3❑ Plastic Go Stainless Steel TO 3 in. to 35 ft. in. to ft. REMARKS. ELEVATION. SOURCE OF DATA - CASINGS RDWEO. CASINGS PERFORATED, ETC. Pump not present. Pip6ing in well was plumbed for a shallow well jet pump. Removed 28ft. 1 -in. drop pipe with 1Yin check valve. Well located basement offset north side of house. Screened porch had been built over top of offset. iFFiCIAL ABANDONED WELL RECORD (May be used for Property Transfer) tea: FXLC Wirt DWD 9. SCREEN ❑ Screened well from ft. to -� ft. (Y4 known) ❑ Open Hole from ® ft. to ® ft. 10. STATIC WATER LEVEL 3 ft. 0 belay ❑ above land surface Date Measured -LL8/20 11. WELLHEAD COMPLETION 1❑ Pitless Adapter 4❑ Found Buried Basement offset d'9 313 Well Pit 12. GROUTING INFORMATION .4ff Neat Cement 20 Bentonite 313 grout material n P at from _to_ ft, cu, yds .cement 3-5— OI feet direction type Well disinfected before seating? at Yes 14. PUMP ® Removed a Not Present Type: 10 Submersible 3❑ L.S. Turbine sn Reciprocating 20 Jet 413 Centrifugal 60 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused wil(s) on property? ® Yes It No Abandoned: [j Permanent ❑ Temporary ® Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my Jurisdiction and this report is true to the best of my knowledge and.belief. Johnson & Sons Drilling 27530 LicT�17 ,n"1161r1 Avenue'`�"ou` h Address r ' nn e a oLL [[1 i s Mn . 5 SignedXL� Date 90 Donn Jo nson Date1,f /90 Hama of Driller 5. DRILLING METHOD (if known) 10 Cable tool 413 Reverse 713 Driven IcO Dug 20Hollow Rod 5Q Air go Bored II❑ Rotary 60 Jetted 9❑ Power Auger 6. OBSTRUCTIONS 77 Wall obstructed a Yes a No d Obstructions romoved WYes ❑ No If obstructions cannot be removed. contact MAW before sealing. 7. USE 1 1SOomestic 413 Monitoring B❑ Heat Loop 20 Irrigation 5❑ Public g❑ Industry 313 Test Well 60 Municipal 100 Commercial MIA 7❑ Air Conditioning 110 S. CASING(S) 1® Black 40 Threaded 70 213 Gals. 50 Welded 3❑ Plastic Go Stainless Steel TO 3 in. to 35 ft. in. to ft. REMARKS. ELEVATION. SOURCE OF DATA - CASINGS RDWEO. CASINGS PERFORATED, ETC. Pump not present. Pip6ing in well was plumbed for a shallow well jet pump. Removed 28ft. 1 -in. drop pipe with 1Yin check valve. Well located basement offset north side of house. Screened porch had been built over top of offset. iFFiCIAL ABANDONED WELL RECORD (May be used for Property Transfer) tea: FXLC Wirt DWD 9. SCREEN ❑ Screened well from ft. to -� ft. (Y4 known) ❑ Open Hole from ® ft. to ® ft. 10. STATIC WATER LEVEL 3 ft. 0 belay ❑ above land surface Date Measured -LL8/20 11. WELLHEAD COMPLETION 1❑ Pitless Adapter 4❑ Found Buried Basement offset d'9 313 Well Pit 12. GROUTING INFORMATION .4ff Neat Cement 20 Bentonite 313 grout material n P at from _to_ ft, cu, yds .cement 3-5— OI feet direction type Well disinfected before seating? at Yes 14. PUMP ® Removed a Not Present Type: 10 Submersible 3❑ L.S. Turbine sn Reciprocating 20 Jet 413 Centrifugal 60 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused wil(s) on property? ® Yes It No Abandoned: [j Permanent ❑ Temporary ® Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my Jurisdiction and this report is true to the best of my knowledge and.belief. Johnson & Sons Drilling 27530 LicT�17 ,n"1161r1 Avenue'`�"ou` h Address r ' nn e a oLL [[1 i s Mn . 5 SignedXL� Date 90 Donn Jo nson Date1,f /90 Hama of Driller SUBJECT '65 City of Fridley 2 0 5 AT THE TOP OF THE TWINS ? BUILDING PERMIT I RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV.j 1i PROTECTIVE INSPECTION SEC.C(J" p l/ NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 9/12/90 JOB ADDRESS 6170 Rainbow Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 KXYXUK Sylvan Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Hildebrandt 6170 Rainbow Drive N.E. 571--5208 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 XO NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 241 x 20 Detached Garage 9 CHANGE OF USE FROM TO STIPULATIONS Garage can not be attached to house without the installation of frost footings under it. Provide a hard surface driveway. WARNING" SEPARATE PERMITS REQUIRED FOR Before digging for .call all, utility locations WIRING, HEATING, PLUMBING AND SIGNS. ' 454-0002 EQt11RED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I 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 $8,57Q $4,29 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- $1081Q0. STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE Fire SC $8.57 $120,86, SIGNATURE OF CONI C O O AUTHORIZEDAGENT IDATEI WHEN PROPERLY VA DATED THI IS YOUR PERMIT Olt) TEI DATE Si NATURE OF OWNERIIFOWNERBUILDER) ID BLDG INSP NEW [ 7 Effective 1/1/90 ADDN L 7 R-1 AND R-2 ALTER [ ] Building Permit Application construction Address: to 1 -10 % u.-J.a 0 k%..) \':� U -k U r- , LLegaa�l,. Description: �p r , Z i -o � K VW11G�L iwitc OC !]4.1UiGsS: ���\� 1�41�.�F. 2@: 'T 'U *'1'eV c' w± ��`l�i� Tel. # Contractor: k -ft r'cJ r-- Tel . Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVIM AREA: Length Width Height Sq. Ft. GARAGE AREA: Length y' WidthHeight Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. 07HER: Comex' Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ j=kEQ= Approx. Completion Date: Proposed Driveway Width If New Opening Is Desired: -G, Ft. $ $ f� /� , j Width + 6' See Back Page DATE: '%19 i �— APPLICANT: „ 1 ��, ' Tel.. # Permit Fee ©O State Surcharge 9 Me 6h= 2�sc- Driveway Escrow $ Park Fee $ Sewer Main Charge $ $ 100.8( STIPt7LATIONS: CITY USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ 7 Not Necessary [ ] I r SUBJECT P City of Fridley 3 0 7 6 8 AT THE TOP OF THE TWINS BUILDING PERMIT r ` R NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. Q r PROTECTIVE 1 � � NUMBERATE REv D PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 3/27/00 JOB ADDRESS 6170 Rainbow Drive NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 1 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Hildebrandt 6170 Rainbow Drive NE 571-5208 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 O NEW 0 ADDITION 0 ALTERATION .0 REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Reroof House & Garage (25 Sq) 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 REOUIRED 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 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 $2,185 $1'09 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. $83.25 Fire0!7$2.19 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL E $ .53 IGNATUpE F ONTRACTOR OR AUTHORIZED AGENT IDATEr N Pqr0FER1r LIDAT SIS YOUR PERMIT iVI111,/p� e 6 S�GNA RE OF OWNER OF OWNER BUILDER,, IDATEI Bl li OAtE r NEW I ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �.�o�� Construction Address: U� ,v v 6-4f 32-- Legal Description: Owner Name & Address: 'Ib Au 0> 4 Tel. # 7 L 3-5-21 - 5 a o'*32 Contractor: 0 o'Vs-'n. MN LICENSE # Address: 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 U a Width a Height Sq. Ft. GARAGE AREA: Length a Li Width 1�t L( Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 4 a v.gG p +v o C (XV -6.e --E 9 S ;6 a. "'TEA"R' O'F Construction Type: Estimated Cost: $ C;/c9s Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 3 -9"7 -" APPLICANT: �C, C01�Tel. # ') (P - S-7 1- 5 9,�5 CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $_ Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ 1,09 $.50/$1,000 Valuation SAC Charge $ $1100 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: $ C. �-&,3