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PRE 2010 DOCSCity Of Fridley, BUILDING PERMIT Date: — April 19, 1968 Owner: James B. Legatt Builder Address 6898 Channel Road Address Sams Same LOCATION OF BUILDING N9 No. 5701 _Street Regis Drive N. E. part of Lot Lot ,_,_20 Block 2 Addition or Sub -Division _—.-Parkview Oaks Corner Lot Inside Lot — X Setback 35' _—_ Sideyard ..... 10' S' Sewer Elevation ____ 917.70 ___ . _ I _ 220.70 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 40' Depth 38' Height 20' Sq, Ft. 1300 Cu. Ft. 26 2 000 Garage Front 20' Depth iU 27'Ncight _101 Sq. Ft. 540 Cu. Ft 5400 Type of Construction Frame Fst. Cost _ _ 18a_009 _ To be Completed 2/1569 SEWER LOCATION - 72' North of Manhole X11= WATER LOCATION - 60.7' North of Manhole 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 a'll provisions of ordinancxs of the city of Fridley. P -� 5100.00 wer Connection Cham In consideration of the payment of a fee of $ !�7 . 00 , permit is hereby granted to James B. Legatt 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 ving of buildings within the city limits and this permit may be revoked at any upon violation of of provisions of said ordinances Of ficial NOTICE: Tbls permit don not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sura to see the Building Inspector for separate permits for these items. y S • i APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEYor MINNESOTA OWNER'S NAME dL t3YLD'r;R s ADDRESS,, _ ADDRESS _ $..' -LOCATION OF BUILDING NO. ®i 'STREET, LOT ['l BLOC�„_ ADDITION OR StIBDYVI$IO1V&d ice' s CORNER LOT .114 bE LOT swoACK •• "• ,S SIDEYARDL—/ R� SEWER ELEVATION TOP OF FOOTING Applicant attach to..thls form,Tw#,;Cextifichtes of Survey of Lot ;and pboposed building' lccati.cn drawn on. these:e�cficates. DESCRIP'IION-•OF BUILDING' To Used Assfl /011/7 Front:,,.,_,..,,. Square feet _,....,Cubic Feet': Front - C� Dept``a11$eight�' Squar f� at a��Cubic Feet,;, Type of Construction ( q��=-Estimated 1o Type To Be Completed .7`_� • /�' The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with tho City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares thaP all he facts and representations stated in this application are tru7eof Corr n DATE�r SIGNATUKL �(Schedu Fee Costs can111V r L X be ford the Reverse Side). i p ■ 4 r rns .00 ,f /� 6+ 1 It 1 1 r Qp� ', �tMST1 ". t C l"C' 2J. , ,;. ' r � 1�* ®®'rte+ n �/� �{+� INDUSTRIAL ' . JOHN A.'PETERSON'' ` �" �" .; ;FRANK- R.',L'ENZ.,JR.' PLATTtNU ' BUSINESS 'ry.� •J`IsVLANG $LJRIV.EYOR$ I r - FARM SURYEYS -CITY LOTS N LAKESkIOttE,- 1 RkOfSTERQQ'UNpE1Z't,AWB OF 6iATE OF MINNEBOT/1 r .0 TOPOGRAPHIC MAPPINR LICENSEQ .Y ORDINANCE$ OR CfT�''OR' MINNAPOLI% _ VUDICIAL , ^y 3300 LYNDAL..E , SO: ;; MINNEAPOLIS; MINN: 5408 r 84a.0370 . i 1``x.1,', 'r V j ,����" � �� t. .��'t �,' � ,t/�! r :•� 4. F }•, t- ! ,•T + t L t ` Y '{ t/', lip us CID Nos, 011 kis I, hereby certify that the .above is a true and correct plat of a survey. 'of: Lot 20, Block 2, PARWIEW [AKS FIRST ADDITION, Anoka County, Minnesota. As surveyed by methis 19th day of April 1960 A.D. Signed: tyli esota 'Registration i..co. 6167 c rulure Connection openings Connected villa' Now Fixture, Old openings Sewer dil I Cesspool F-1 City of Fridley: Aftoffim 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 applicatlon. are true and correct. Fridley, Minn.- gq 1949 - Owner Kind of 411ding Used as To be completed about Estimated Cost, $ PLUMBING FIXTURE RATES: NO. RATE TOTAL Old—New. Building Permit No.---- —permit No. ' Number Fixtures ... 7 0'0 x $2.00 $ Z3� Signed - Future Fixture Opening x $1.50 $---3 &10. By - New Fixture Old Opening LUG x $1.50 $ Business No.__ No CatchBasin x $3.25 it Water Heater (Up to 99,000 BTU) X $3.00 $. New Ground Run Old Bldg. x $3.26 $ ROUGfk_� Electric water Heater z $2.00 $ r FINAL GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... x $200 $ It .... ... .._ Additional Fixtures .... .............. x $ ,M $ have- -IV /e c C-" S 'c Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code N'?� 0 MEN MEN MEME rulure Connection openings Connected villa' Now Fixture, Old openings Sewer dil I Cesspool F-1 City of Fridley: Aftoffim 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 applicatlon. are true and correct. Fridley, Minn.- gq 1949 - Owner Kind of 411ding Used as To be completed about Estimated Cost, $ PLUMBING FIXTURE RATES: NO. RATE TOTAL Old—New. Building Permit No.---- —permit No. ' Number Fixtures ... 7 0'0 x $2.00 $ Z3� Signed - Future Fixture Opening x $1.50 $---3 &10. By - New Fixture Old Opening LUG x $1.50 $ Business No.__ No CatchBasin x $3.25 it Water Heater (Up to 99,000 BTU) X $3.00 $. New Ground Run Old Bldg. x $3.26 $ ROUGfk_� Electric water Heater z $2.00 $ r FINAL GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... x $200 $ It .... ... .._ Additional Fixtures .... .............. x $ ,M $ have- -IV /e c C-" S 'c Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code N'?� suadEcr PER T NO. City of Fridley 14080 AT THE TOP OF THE TWINS PERMIT S �L ______ COMMUNITY DEVELOPMENT DIV. BUILDING k Lf PROTECTIVE INSPECTION SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF. APPROVED BY 612-560-3450 910-F15 5/12/77 JOB ADDRESS 5701 Regis Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 20 2 Parkview Oaks SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Legatt 5701 Regis Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Patio Village 3918 49�i Street West,`Mpls. 926-2771 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Rsidential 7 CLASS OF WORK ❑ NEW Ej ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Construct porch enclosure 18' x 12' 9 CHANGE OF USE FROM TO STIPULATIONS Area can not be heated unless structure were altered to meet the Energy Code. WARNING . Before digging call local utilttlee TELEPHONE - ELECTRIC 'GAS E ,EERATE PERMITS REQUIRED FOR WIRINC-4 REQUIRED BY LAW IDEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. A41 - PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. $5,400 $2.70 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 F_ ANY OTHER STATE OR LOCAL LAW REGULATING CON. - STRUCTI O THE PERFORMANCE OF CONSTRUCTION. $33.00 PLAN CHECK FEE TOTAL FEE L -f:$35.70 HEN PR P L V LI TED THIS IS YOUR PERMIT SIGNATURE OFCONTRACT AUTHORIZED AGENT (DATE) BLDG.INS DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) :%-.. r. COULTER': & ..ASSOCIATE'S;'I NC.:: . InDusrRIAL JOHN A. PETERSON. .,-,,'FRANK R.IXENZ..JR. PLATTING DS S.AESS - 'LANG SURVEYORS a .• MRTd SURVEYS clrY Lors REGISTERED UNDER LAWS OPSTATE,OF MINNESOTA LAKE:HORE l TOP039A?HIC MAPPING' LICENSED .Y'ORDINANCES 0I CITY"OJ MINNEAPOLIR- - , iVOIC1A4 3300 LYNDALE AVE. SO. MINNEAPOLIS. MINN. 85408.;. w 824-0370. „ j .'Ourbcpar'm;; Certificate. 71 N oM I o L a.„ •' .. "' .moi Q z IV Cry f e a r LV I hereby certify. that the above is a true and correct plat of a survey• •of: - Tot 20, Block 2, PARKVIEW QAKS FIRST ADDITIONI ,Anoka County, Minnesota. As surveyed by me this 19th day of April 1960 A.D. Signed .,• ' S,:i : e s o to Registration No. 62-67 CITY OF FRIDLEY, APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: ���%® L�,'T BUILDER: i ®f.#. Q Address: 4 0I � is L�[ZAddress: Z 3}/ 8 ® j/ Tel. No.: --926-7-771 • No.: 57C r Street:REg 15 LOT: 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 these Certificates. DESCRIPTION OF BUILDING Be Used As: Ek,C.LdSyA&.. Front: 148 Depth: I2 Height: Square Feet: 21 6 Cubic Feet: Front: i Depth: Height: Square Feet: Cubic Feet: e a Type of Construction: �R, E �jLASS Estimated Cost: $ 291 To Be Completed: L !,!U Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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 representat' s stated in this application are true and correct. See reverse side foZ a ition :5orma;zion. DATE: JZ /"7 `�J SIGNATURE: Stipulations: SUBJECT M ITN . City of Fridley 0.7 9 AT THE TOP OF THE TWINS P E R'v,� BUILDING A� T P RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. 1 kAP-PAk0VEO:-?By, CITY HALL FRIDLEY 55432 ti.__.11.' '•� NUMBER REV DATE PAGE OF 612-571-3450 910-F15 6/22/00 10B ADDRESS 5701 Regis Drive 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 20 2 Parkview Oaks SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Legatt 5701 Regis Drive 571-5500 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Steven R. Lee 9465 Irving Ave. No. Brooklyn Park, MN 55444 424-1198 5758 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 IN REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage, tear off 26 squares 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 $2,272.00 $1.14 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- STRUC ORMANCE OF CONSTRUCTION $83.25 Fre SC $2.27 PLAN CHECK FEE TOT ;FEE C Lic 5.091.66 SIGNATURE OF CONTRACTOR OR AUTMOR12E0 AGENT IDATEI - EN O ALI TE THIS IS Y9,LIR P�R�IA� BED CINSO (/� �A TE S,GNATURE OF OWNEROF OWNER BUILOERI IDATEI NEW L l Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION I � 0 Construction Address: Legal Description: Owner Name & Address: �-e© �%` Tel. # -r- 71 �-�- Contractor: _ �- �.r �-�� MN LICENSE # S ? Address: L/ (o S— Y Z. -r ti' Tel. # yam, Attach to this application, a Certificate ofrvfy 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 Width Hgt/Ground Sq. Ft. OTHER: 0,x,2 X?. 66 . Construction Type: Y-e--Y-�Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $_ DATE: - &CPPLICANT- _ r Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee Fee Schedule on Reverse Side Fire Surcharge $ 7 .001 of Permit Valuation (1/10th%) State Surcharge $ l $.50/$1,000 Valuation SAC Charge $1100 per SAC Unit License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above R $450.00 Conservation Plan Review $ Fee Determined by Engineering $ $ Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY PERMIT N.: 2004-0062 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/07/2004 572-36U4 VAN: (763) 571-1LIf7 ADDRESS : 5701 REGIS DR NE PIN : 243024310073 LEGAL DESC : PARKVIEW OAKS 1 ST ADD : LOT 20 BLOCK 2 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RESIDING VALUATION : $ 11,341.00 NOTE: PER R703, 2000_,INTERNATIONAL RESIDENTIAL CODE, REQUIRES THAT A WEATHER RESISTIVE BARRIER BE PLACED OVER EXTERIOR SHEATHING 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. APPLICANT SELA ROOFING & REMODELING 4100 EXCELSIOR BLVD ST LOUIS PARK, MN 55416- (612)823-8046 �4'X LEGATT JAMES B & COLETTA D 5701 REGIS DR 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 regulating construction or the performance of construction. ADDlicantc"°, n Date , i BUILDING PERMIT FEE 209.25 FIRE SURCHARGE 11.34 STATE SURCHARGE, VALUE 5.67 TOTAL 226.26 PAID WITH CHECK # 3161 ARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. MAY. 3.2004r 8�11AM SELA GUTTER J N0.379 P.2/2 iDLL� Effectivd 171/2004 f ,64314 University Ave NE ERCI L & INDUSTRIAL v9 Fridley, MN 55432 BUILDING PERMIT APPLICATION (763 ) 572 -3604 FAX ( 763) 571-1287 a� 1 .66 �o, I CONSTRUCTION ADORES Legal Zoning Owner & Address�o �.S Tel# (Al)�IwS5-cc o -CONTRACTOR & ADDRESS le. , LOZ./Z',ee,..,-, Tel# (�) 9� 3q00 a0 -L a.Le W z�"I"--- Architect Reg.# Engineer Reg.# BUILDING CONSTRUCTION TYPE OF WORK ;5 New [] Addition [] Alteration -Describe /l OFC. AREA: Length Width Height Sq. Ft. WHSE AREA: Length Width Height Sq. Ft. OTHER AREA: Length I Width Height Sq. Ft. APPLICANT J��� r (//,y/��/9G� ''%��ate`7 r VALUATION Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) �� Sq. Ft, x $ Cost/Sq. Ft. = Valuation $ ) = $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE Building Use Construction Type Occupancy Group Air Conditioning []Yes []No Fire Protection Provided []Yes []bio Performance Bond Amount $ See Reverse for Schedule Received []Yes []No PERMIT FEES Permit: Fee $ See Fee Schedule on Reverse Side Plan Check $ In Excess of Prepaid Amount - See Reverse Side Fire Surcharge $ A .001 x Permit Valuation (1/10th %) State Surcharge $ $.50/$1,000 Valuation (See Sched. for > $1 Million) SAC Charge s 81350 S Erosion Control Park Fee $ Spec. Assessments $ Curb Cut Escrow $ / TOTAL S— AI (p - �tp per AC Unit (Plans to MWGC for determination) $450.00 Conservation Plan Review Fee Determined By Engineering Agreement Necessary [] Not Necessary [] feet x $17.00/foot ATTACH STIPULATIONS City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 PLUMBING Permit No.:Building ob - ��Y Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY DATE 77 —10 —0 -7 YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY NAME: -3-j ,4�(e �yLE�c> �i� ADDRESS: S'70E - �ge5 �%�. CITY r tl�STAicy 4QZIP��i �-ry OWNER/ TENANT PHONE:y CONTRACTOR NAME:, STATE LICENS-E# `7e���ve® EXP DATE 1? -3 v`? SUBMIT A COPY OF YOUR STATE �1 ADDRESS: t c311 - 41=_ CITY Y� STATL�a�(ZIP�� LICENSE WITH PHONE -Of FAX APPLICATION PERMIT TYPE M-9 GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT DETAILED DESCRIPTION OF WORK 7;1�5`E, & Se;�F� PEP, MS 1613.665 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 un r $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) BATH SINK/LAV DRAINS SHOWER _ WATER PIPING _ _FLOOR _ —BATHTUB _ GAS PIPING mm crartrcvat) _ SWIMMING POOL _ WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) _ _ _ _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION —DISHWASHER WATER METER OTHER Permit Fee $ _ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ IS- . State Surcharge = $____.150 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 is not to start without a permit; that the work will be in accordance with the approved plan in the case of all + rk whi requires review and approval of plans. lJ .,. r/ — 07 SIGNATURE OF APPLICANT PRINT NAME DATE 2 F,. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977