PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N° 1, 4920
Date: ............. _......... .....................
........._... ... _:......_...._..
Owner: _ ,�._% i� Builder
.............._.... _......... ....... _.._..._..._......__..____.__ _.....___._.._.__......
Address _:....... - "'' > Address _.....___._..__.
. LOC TION OF LDI G
No.... ._........ Street ....._._;. .. w.. ......... _..: .:�. Part tf ........: _ .... ._.. ......._............
Lot .............. ..................... Block ....._.........a: ! ............------------- Addition or Subdivision _.:...::....... :..........:..:. ....:..... ....:...:...... ...:....
Setback ....._.....:. _. / °►
Corner Lot .......................... ......... Inside Lot _..._. ....._-. ..:_... Sideyard ...._....! ......_........._............._....-
Sewer Elevation . .... _............................ .............. _........... ............... _................... Foundation Elevation
DESCRIPTION OF BUILDING
To Used as
..... .......: Front __� Depth ..... Height Sq. Ft... Cu. Ft. .++ ".
�/ :...... ,p ..... Front ....., . Depth ...... eight ...... Sq. Ft... Cu. Ft. `.......
Type Construction . !._.- .._ .:..:....._...... Est. Cost .:::... --..._.... 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 with all provisions of
ordinances of the city of Fridley.
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
within the city limits and this permit may be revoked at any tim o violation o any of the provisions of said
ordinances. ,/" I
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
APPLICATION FOR BUILDING PEIUaT
CITY OF FRIDLEY, MINNESOTA
Owner Is Name Je Fi ki, 14 P F Builder J 0 X A-)
Address 1 �% 'l mac- ,f, p�ddress 21-/r I S Z
_ LOCATION OF BUILDING
1:2, � _ .
no. V4, Part of Lot
Lot Block S Addition or Subdivision
Corner Lot Inside Lot ) Setback_____ Side -Yard jP
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
F
DESCRIPTION OF BUILDING
A� f
/�� W Ala -4.1 111Gn-
w
i
Front -A61 Depth i2L, Hei
Sq. Ft. 12-0 Cu.
Ft.
ht
0 /
Sq. Ft. L/ C D 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 Ordinances and ruling of
the Department of Buildings, and hereby declares that the facts and repre tations
stated in this applicatio are true and correct.
DATE'' _ SIGNATURE �r
(A Schedule of Fee Costs can be found on the Reverse Side.)
u
�'l APPLICATION FOR HEATING OR POWER PLANT AND SPECIAL DEVICE PERMIT
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ......................... 8.00 $
Replacement of Furnace ............................. 4.00 $
Repairs & Alterations—up to $500.00 ................. 4.00 $
Repairs & Alterations each add. $500.00 ............... 2.00 $
MECH. WARM AIR /
Furnace Shell & Duct Work to 120,000 BTU ........... 8.00 $ t/
each add. 60,000 BTU ........................ 1.00 $
Replacement of Furnace ............................ 4.00 $
Repairs & Alterations—up to $500.00 ................. 4.00 $
Repairs & Alterations each add. $500.00 .............. 2.00 $
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. IDR Steam ...................... 2.00 $
Each add. 320 sq. ft. IDR Hot Water .................. 2.00 $
OIL BURNER to 3 gal. per hour ........................ 4.00 $
over 3 gal. per hours—See Fee Schedule
GAS BURNER .......................................... 4.00 $ e,/
GAS PIPING (Up to 5 Fixtures) .......................... 1.25 $ t/
AIR CONDITIONING
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM 8
REMARKS: TOTAL FEE $�
Dept. of Bldgs. Phone JU.
Village of-
The
f The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the Village Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are
''true
6�and correct.
Broo enter, Minn. Clr , 11)14.4
Owner 195—
Sind of
Used as
CAPRIMPIM
To be completed about
Estimated Cost, $ <,® d
Old New. ding Permit No-'
%
HEATING or
Trade
DESCRIPTION OF WORK
Hot Water Warm Air No
Size Noke
195—
Capacity. Sq. Ft. E.D.R.0 7� ° � BTU H P.
Total Connected Load oj� Sind of Fuel/moi
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D R BTU H. P.
RAY .N. WELTER HEATING CO
Signer 4637-6HIE.
By. MINNEAPOLIS 7, MINNESOTA
1 1 3M-3-59 Business Phone No Jee -1 r - e-+ f 4 %
Ciiy of Fridley
Application for Plumbing and Gas Fitting Pe'-rn*
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE
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) ...... Z x 2.00
New Ground Run Old Bldg. x 3.25
City of Fridley:
The undersigned hereby .makes application for a permit for the work herein
specified, agreeing to do 011 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 an* correct.
1gz-d
Owner
of Building
Used as
To be completed about
Estimated Cost, $ _
Old—New. Building Permit No Permit N
TOTAL o
Sign `®
$ Business Phone No.
ROUGH®� L O
FINAL
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $ Z` ':�
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE az 2M 7-59
0
W•
�GO
F
w
N
WATER HTR.
GAS
ELEG
Base
1st
2nd
_
3rd
4th
Future Connection Openings
Connected withI Bower
New .Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE
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) ...... Z x 2.00
New Ground Run Old Bldg. x 3.25
City of Fridley:
The undersigned hereby .makes application for a permit for the work herein
specified, agreeing to do 011 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 an* correct.
1gz-d
Owner
of Building
Used as
To be completed about
Estimated Cost, $ _
Old—New. Building Permit No Permit N
TOTAL o
Sign `®
$ Business Phone No.
ROUGH®� L O
FINAL
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $ Z` ':�
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE az 2M 7-59
SUBJECT
RE_
Cityof Fridley
'o 193 4 6`
AT THE TOP OF THE TWINS
BUILDING
PERMIT
_
-
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
O
r PROTECTIVE
(®
1 i 1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
'j
L 612-571-3450
910-F15
3/18/88
JOB ADDRESS 277 Rice Creek Boulevard N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Kenneth. Pederson same
571-2926
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Robert Wilson-
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 ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof
9 CHANGE OF USE FROM TO
STIPULATIONS
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
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
$1,200
$.60
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.
929XM $20.50
PLAN CHECK FEE
TOTAL FEE
$21.10
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
r WHEN P PER LIDATED T IS IS YOUR ERMIT
SIGNATURE OF OWNER IIF OWNE BUI DER) IDATEI
BLDG INSP
SATE
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address:
Legal Description:
Owner Name & Address:
Tel . # S �
Contractor: T®l. #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length 70 Width o Height
Length a Width Height _
Length Width Hgt/Ground
Sq. Ft. % U
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: Al Estimated Cost: $ �a
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: APPLICANT: re9 Tel. # 3 7 7`-�
CITY USE ONLY
Permit Fee $C5 Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ � 0 $.50/$1,000 Valuation
SAC Charge $ $ 5,5Q per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
TOTAL $
Agreement Necessary [ ] Not Necessary [ ]
��. / �
STIPULATIONS:
SUBJECT
ERIMiTINO.
City of Fridley4
`"Rte,
6 9.
AT THE TOP OF THE TWINS
BUILDING
P E R M I T(-
o
COMMUNITY DEVELOPMENT DIV.
r a. PROTECTIVE INSPECTION SEC.
1 . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
18/31/98
JOB ADDRESS
I LEGAL
LOT NO. BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
18 3 1
Rice Creek Plazao North Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ken Pederson
571-2926
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE `-'LICENSE NO
Tabor & Sons Inc. 3716 St Francis789-1902
2001424R
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 Jac REPAIR 0 MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof house and garage 20 S Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
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
$1668
S.83
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.
$54.00
Fire SC $1.66
.? I — _p
--des(
(541ti-k 9�__
PLAN CHECK FEE
TOT L FEE
- —f
Lice
5.
61.49
SIGNATURE OF CONTRAC OR OR AUTHORIZED AGENT (DATEI
VALID T THIS IS YOUR PER IT
k�f;E4NIPROP
SIGNATURE OF OWNER pF OWNER BUILDER) IDATEI
SP
PATE
NEW [ Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 x\6�
BUILDING PERMIT APPLICATION �u
ConstructionAddress: ) W 'C2, C r7 -e
Legal Description: '5"'^ -) /&
Owner Name & Add e ie P r5oA-J Tel. #
Contractor: 50'z/s MN LICENSE #
Address: "`3 Is ofup Tel. # °-7
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
Sq. Ft.
GARAGE AREA:
Length
Width
Height
Sq. Ft.
DECK AREA:
Length
Width
Hgt/Ground
Sq. Ft.
OTHER:
License Surcharge
$
gcLAr'e
Construction Type:
d 6
Afe
Estimated Cost: $
CC)
$
$450.00 Conservation Plan Review
(Fee Schedule on
Back)
Driveway"Curb Cut Width Needed:
Ft. + 6 Ft =
Ft x $
_ $
DATE: APPLICANT: Tel. #
CITY USE ONLY
Permit Fee
$
CIC-)
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
16
$.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 [ J
TOTAL
$
STIPULATIONS:
NEW [ ] CITY OF FRIDLEY d' C + L)`C6—� Effective 4/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
11-1
Construction Address: CD -I &r e, IUI
Legal Description:
Owner Namee& Address:�(1 d�c�lC'WTel. 4
Contractor. t nna& U--ferlo(s MN LICENSE # 6C-iAr]%
Address: A CLZ_ Tel. # 16344gL
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
Sq. Ft.
GARAGE AREA:
Length
Width Height
Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground
Sq. Ft.
OTHER:
Construction Type: 10 0� ri&05 'ido 126SAM Estimated Cost: $ f Low
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #--)to3 :55z1
U
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 $ 074s,-zr
Plan Review
$
Fire Surcharge
$
State Surcharge
$-�
SAC Charge
$
License Surcharge
$ ��-
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ 499-�-72—
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$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 [ ]
STIPULATIONS:
FEES ARE BASED 0,11$10.00 i'ER FIXJIURL xi P tVHL1 E NOf EaD.
EgII]POWnt w-Wied M1' 3:
MFG. -
MODEL:
_,_A/C $25.00 MFG: MODEL; _—
`AIR TO Alit EXCHANOEUR $ I5 FIRE LACE (GAS? $15.00
—BOILERS35.00 FIUPLACh (WOOD) $35.00
_CHIMNEY LINER$10.00 �RNACES35.00
_DUCT WORK $10.00~GAS DRY ER $10.00
s�r,.;ta:x: a.•.•c..: x:»n : ,.....:,.:.................... CTAS PIPING $10.00
SLi•XACH
SIZEIBTU
SLZI;V 4TU _
_GAS RANGE/OVEN $10.00
_NEW GAS GRILL $10.00
_GAS UNIT HTR $10.00
_POOL HEATER $35.00
—VENTILATOR $15.00
,. a:...,•.v
THIS IS AN s>Ti•P7'n' ':. r'fiha: ;"}7vvP:ri:• !($L :'r::ip`': �%[1x4i M;
APPLICATION FOR A PXRMIT NOT VALIV UNTIL PROCESSED
I heresy apply for a buliding permit and I Acknowledge Chat the information above is complete and accurate; that the work will be in
c01nf6ntMec with the ordinances And codes of the City of Fridley and with the Minnesota Con%truetion Coda; that I understand this is
not a permit but only an aAplic ation for a Permit. and work is not to start without a permit; that the work will be in accordance with the
approved plan in tho case of all ork whicreview and approval of plans
SIGNATURE OF APPLICANT %
PRINT NAME DATE
a„w.
...die
:«..n , ..4 •v . z1�:{�.'. A.tr�rrx.. sn..,.n.......,...,,...�..�.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, UN 55432
763-572-3604 FAX 753-502-4977
From: unknownPage: 3/3 Date: 6/4/2009 4:18:10 PM
Building
+.
1-111. .14y to rrruley I o: /6jCz289$8 Page: 2/3 Date: 6/4/2009 3:40:27 PM
MECHANICAL Permit NO.:
I63-57 t-360ous
763-572-3604
RESIDENTIAL APPLICATION Received By: ' a
763-502-4977 FAX CITY OF FRI.DL '► Y nate G'D J
DATE
r� >=lzFECTIVF Z-l9d19
SITE ADORM
rl YOU% *"MAI ADDRESS? IlGLC. '�sr +jP,
+
THIS APPLICANT IS:
❑ OWNER OCONTRACTOR
PRQPERTVr
NAME' — —
OWNERI
TENANT
ADDRESS: + CITY STATE
PtION>r;
f�r
Wi— 703-J&o-101W
GONTI�AG'!'C1R
COMPANY NAME;
SUBMIT A COPY OF
CONTACT PERSON:
YOUR STATE
LICENSE WITH
STATE LICENSk. f► EXP DATE"^
APPLICATION
ADDRESS: �
rye ���1,
PHONE. 7 103_�P
FAXSTATZi1PA�
A997 C. C10—
PERMIT TYPE
Qa,41Lk FAMILY p TWO FAMILY O TOWNHOUSE
TYPE OF WORM
❑ NEW U4PLACEMENT C3 ALTERATION/RL•:MOUEL
DETAILED DESCfUPTION OF WORK
FEES ARE BASED 0,11$10.00 i'ER FIXJIURL xi P tVHL1 E NOf EaD.
EgII]POWnt w-Wied M1' 3:
MFG. -
MODEL:
_,_A/C $25.00 MFG: MODEL; _—
`AIR TO Alit EXCHANOEUR $ I5 FIRE LACE (GAS? $15.00
—BOILERS35.00 FIUPLACh (WOOD) $35.00
_CHIMNEY LINER$10.00 �RNACES35.00
_DUCT WORK $10.00~GAS DRY ER $10.00
s�r,.;ta:x: a.•.•c..: x:»n : ,.....:,.:.................... CTAS PIPING $10.00
SLi•XACH
SIZEIBTU
SLZI;V 4TU _
_GAS RANGE/OVEN $10.00
_NEW GAS GRILL $10.00
_GAS UNIT HTR $10.00
_POOL HEATER $35.00
—VENTILATOR $15.00
,. a:...,•.v
THIS IS AN s>Ti•P7'n' ':. r'fiha: ;"}7vvP:ri:• !($L :'r::ip`': �%[1x4i M;
APPLICATION FOR A PXRMIT NOT VALIV UNTIL PROCESSED
I heresy apply for a buliding permit and I Acknowledge Chat the information above is complete and accurate; that the work will be in
c01nf6ntMec with the ordinances And codes of the City of Fridley and with the Minnesota Con%truetion Coda; that I understand this is
not a permit but only an aAplic ation for a Permit. and work is not to start without a permit; that the work will be in accordance with the
approved plan in tho case of all ork whicreview and approval of plans
SIGNATURE OF APPLICANT %
PRINT NAME DATE
a„w.
...die
:«..n , ..4 •v . z1�:{�.'. A.tr�rrx.. sn..,.n.......,...,,...�..�.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, UN 55432
763-572-3604 FAX 753-502-4977