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PRE 2010 DOCSCity of Fridley, M BUILDING PERMIT N? '7031 Date: Owner: Builder Address Address O O ING No. Street - � � ,s 'f �° � Part of Lot -- __ Block Addition or Sub -Division e Corner Lot , Inside Lot Setback__ _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING T 'fie U as: Front _ Depth Height Sq. FL Cu. o nt Depth eight Sq Froei t �� . Ft. Cu. Ft. -�--- P Type of Construction Fast. Cost _ .'moo be Completed In consideration of the issuance to me of a permit to construct d the proposed work in accordance with the description above set, fo in ordinances of the city of Fridley. „ to do ins of In consideration of the payment of a fee of $ , permit is hereby granted to— to oto 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 of any of the provisions Wada ordinances. � A Building Inspector NOTICES This pem b does net corer the construction, inata0tlton for whing, plumbing, gas heating, sewer or water. Be core to we the eotldhng htapector for soparato permits for thus ttsm& City of Fridley Application for Plumbing and Gas F'itti'ng Permit DESCRIPTION OF WORK Number. Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES:O. RATE TOTAL Number Fixtures x $1.50 $oz 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 $ ' G New Ground Run Old Bldg . ............ x 3.25 $ 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 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $-tea 1 Dept. of Bldgs. Phone SII 4-7#70 a 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 application , are true and correct. Owner � Kind of Building Used as To be completed about Estimate Cost, $ Old New. ding Permit ROUGH -6- '" l � `� 7 FINAL 19a9� Sul�Yu w Z • • N WATER HTR. ELEC. �p F GAS Base 1st 2nd 3rd 4th Future Connection Openings Connected with e New Fixture, Old Openings Sewer El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES:O. RATE TOTAL Number Fixtures x $1.50 $oz 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 $ ' G New Ground Run Old Bldg . ............ x 3.25 $ 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 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $-tea 1 Dept. of Bldgs. Phone SII 4-7#70 a 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 application , are true and correct. Owner � Kind of Building Used as To be completed about Estimate Cost, $ Old New. ding Permit ROUGH -6- '" l � `� 7 FINAL 19a9� C Date: _ Jul 7 ., 1965 Owner: Carl Larson Address 480 Aire Creek Blvd. Builder Address 160 Hartman Circle Charles E. Johanson LOCATION OF BUILDING No. 480 Street Rice Creek Blvd. Part of Lot Lot 11 _ Block 1 Addition or Sub.Division Holiday Hills Corner Lot _ Inside Lot _ Setback Sideyard Sewer Elevation ____ _ Foundation Elevation To be Used as: Front Front Type of Construction Storm damage repair DESCRIPTION OF BUILDING N° 8129 3ol6ol Depth Height Sq. Ft Cu. Ft Depth Height Sq. Ft Cu. Ft — Est Cost $12,000.00 _ To be Completed In consideration of the issuance to me of a permit to const the proposed work in accordance with the description above set ordinances of the city of Fridley. above I agree to do kith ail provisions of In consideration of the payment of a fee of $ 10x. , permits hereby granted to Cas E • Joh son 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 add his agents, employees and workmen, in all work. Fri�ey Minnoan ta rnaugardin dlobcatiocobstri%tion, alteerati n��aint�enaace� and mo seg orf bunildtngs within the dty limits and this permit may be revoked at any time upon violation of any of the provYslons of said ordinancrea Allen Jensen Building Inspector NOTICE Uh permit doer not cover the construction, oda for wiring, phmbing, gas hedhM sewer or water. Be sura to as the Building hupestor for separate permit, for there bm& e APPLICATION FOR BUILDING PERMIT -'CITY 07 FRIDLEY, MINNESOTA J OWNER' S NAME .r) W4. BUILDER Se a. ADDRESS _ f/ ,2 � � f- i_ r 13 y iyg ADDRE3s LOCAT16N-OF BUILDING No. Street Part.of Lot t LOT % BLOCK ADDITION OR SUBDIVISION, Corner LotInside LOT Setback - Side -Yard SEWER ELEVATION FOUNDATION ELEVATION 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; Front Depth. ..,Height Sq. Ft. 'Front Depth Height— Sq. HeightSq. Ft. Cu. Ft. T e `of .Construction 3?P Eatimated Cost .2. �`� �' 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 Department of Buildings, and hereby declares than all the facts and representations stated in this application are true and oprrect. DATE SIGNATURE® (Schedule of Fee Costs can be found on the Reverse S 4 . . m - . . -0 City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PE 1812 r • L COMMUNITY DEVELOPMENT DIV. v-'---- E✓ PROTECTIVE INSPECTION SEC. 1 = i CITY HALL FRIDLEY. 55432 %j 612-571-3450 CEIPT NUMBER 910-F15 REV. DATE 7/25/85 r;GE OF / APPROVED BY JOB ADDRESS 480 Rice Creek Boulevard 1 LEGALLOT DESCR. NO. 11 BLOCK 1 TRACT OR ADDITION SEE ATTACHED Holiday Hills Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert/Doraine Peterson 480 Rice Creek Boulev and N.E. 571-8278 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 ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Construct a 511411 x 14`4" Deck onto Back of Duelling 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED VALUATION ` SURTAX WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4,600 $2.30 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. $50.50 PLAN CHECK FEE TOTALFEE $65.43 IG URE OF CONTRACTORIZEDAGENT (DATE) WHEN PROPERLY V,PLIDATED THIS IS YOUR PERMIT BLDG )NSP UFO-- $iGNATU EOF OWNER IIF OWN BUILDER) IDATEI NEW [ ] ADDN. [ ] ALTER. [ ] Construction Address: Legal Description: Owner Name & Address: Contractor: SF Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: City of Fridley Effective 4/1/84 �R-1 AND R-2 Building Permit Application 01 Tel. # S,Y M7 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_ eWidth Hgt/Ground L Sq. Ft. Corner Lot [ ] Inside Lot[ ]��11 Ft. Yd. Setback Type of Construction: �� rrty Approx. Completion Date: W^ 1,7 - Side Side Yard Setback Estimated Cost: $ A ZVOO Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: ? APPLICANT: Tel. # Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] MEMORANDUM TO: John G. Flora, Public Works Director PW92-046 Mark A. Winson, Ass't Public Works Director FROM: Jon Thompson, Estimator and Construction Inspector DATE: - February 19, 1992 SUBJECT:. Additional InformatiomConcerning Problems with the 1992 Spring Thaw MISSISSIPPI RIVER The elevation of the top of the flood control dike on the Mississippi River West of Riverview Terrace near 79th Way is 824 feet above sea level. The top of the. road where the 60" CMP culvert goes under 79th Way between Broad and Riverview Terrace has an elevation of ± 818. Therefore the culvert will have to be sandbagged and.pumped, and the road built up 6 feet'to keep water from flooding the homes in the surrounding area. In order to build a dike across 79th Way, 675 C.Y. of fill would be necessary. The dike would be 100 feet long, 6 feet high and 40 feet wide at the bottom and 20 feet wide at the top. It would protect the 67 homes listed on page 2. RICE CREEK The homes at 470, 480, 490, 567 and 573 .Rice Creek Blvd, 6801 Channel Rd, and the home at 580 69th Ave NE seem to be built higher than the 100 year storm line, but their lots will have extensive flooding from the high water. See attached summation sheet and map. 52ND AVE NE The spring thaw could also affect the homes at 1280, 1298 and 1300 52nd Ave NE. These properties flood from extensive storm runoff and are potential candidates again this spring. February 19, 1992 Page 2 RIVERVIEW TERRACE 8053 Riverview Terrace 8215 Riverview Terrace 8041 Riverview Terrace 8241 Riverview Terrace 8031 Riverview Terrace 8151 Riverview Terrace 8021 Riverview Terrace 8181 Riverview Terrace 8001 Riverview Terrace 8191 Riverview Terrace 7995 Riverview Terrace 8141 Riverview Terrace 7965 Riverview Terrace 8125 Riverview Terrace 7941 Riverview Terrace 8121 Riverview Terrace 7921 Riverview Terrace 8065 Riverview Terrace 7901 Riverview Terrace 8095 Riverview Terrace BUFFALO STREET 581 Buffalo Street 641 Buffalo Street 611 Buffalo Street 600 Buffalo Street 621 Buffalo Street 630 Buffalo Street 631 Buffalo Street 541 Buffalo Street 639 Buffalo Street 560 Buffalo Street FAIRMONT 645 Fairmont 675 Fairmont - 689 Fairmont 695 Fairmont ELY STREET 600 Ely Street 625 Ely Street 630 Ely Street 635 Ely Street 640 Ely. Street 651 Ely Street 650 Ely Street 655 Ely Street 680 Ely Street 681 Ely Street 684 Ely Street Street DOVER STREET 625 Dover Street 610 Dover Street 631 Dover Street 620 Dover Street 641 Dover. Street 680 Dover Street 665 Dover Street 640 Dover Street 681 Dover Street 680 Dover Street 670 Dover Street CHERYL STREET. 609 Cheryl Street 661 Cheryl Street 615 Cheryl Street 600 Cheryl Street 657 Cheryl Street 630 Cheryl Street 641 Cheryl Street 640 Cheryl Street BROAD. STREET 7899 Broad Street 7895 Broad Street February 20, 1992 Page 3 HOMES THREATENED 'BY RICE CREEK IN FRIDLEY 470 RICE CREEK BLVD 824.74 823.00 480 RICE CREEK BLVD 824.74 823.00 490 RICE CREEK BLVD 837.50 829.00 580 69TH AVE UNKNOWN 831.00 567 RICE CREEK TERR 830.47 830.30 573 RICE CREEK TERR 831.27 830.27 6801 CHANNEL ROAD 1 852.70 852.50 21 N//4 CORNER. -231s„ ,tf,vy. S& %4....... - aY eo - q9 0) *,e x�C. .. �. 69TH N.E.— `I4 = Rif- ci `, 3S� a h o,A t� CO > 4L 1") y�S61 a - ° 2. J w 0 �� fi o° 4 2 I i� y�3•Izz.. e � 3 �^- • is V� \� \ y i -' •' r '' /9 5 flip � pv��o ��, h`� � = os 5 b � `,x 1�' Cil7 \.. �a$r • A . � , ,`` /v w`kti.�,. �. •• it �6�v /„ 7 ? 0• Ti �Jjj / r �� hO ^c .I=J \ � � }F o � �% o. ' `i7 `y ' .�•o :t��t Ji4t�' � �1 \ L 5•� I� ° Q- 5.66 a �° l •' j� l.f*� % l{ �1 `/ °•6^fitV • I ,� SP•!i4 1 �\ Y 'Q �� ase V (SZ !.• \°• . O 4 531 • �• \ FSR �� .?It. �-- 5§9 e/ Ioy ��'� \ �.`s �S� .re�s�' :sf1 s� �; � ` t°�'; �• ,i�,.r•Ss;;.. ' n �/� �' � y�� '� ti � v ¢'� e - `•o'+ : oi�•,�� i �~ B 'fit \ N�: \t4S% Y• �� j'� 190 • r s a I 301 \\ �4 �.� k: • w r. 5 ��' ? z ' , �� a 4, 5 d 01d l I • 4\qi. \` . r(i�� -� n cg'P'- �o .f'.r�F- �N�+�_"�. , tori-�., 10 G s 1h t 1h IQo � •, r• t• 1\/ J g�.' •�°v_ kill) ' 14 - v 9i`°',••��, •.D.�M11'ltea�,';b65a�Yb7�'(ra) �' ''•r O�v a 1 7Q b `5737 ` r a1� ' ' qv 7 � � N � 1 0 (a9) s° s.)t„1 l�h ,�Jt ��'� ae ° �, �� a 11 'r\h •.� \3I�.' LO rJ ? \_ r?'^e�•\\ g•`.. oy� ° •O~lJgt� (�: ad4 ?0 46 Lj N Terroce x'140 eel ked °1 0 43�,, - 8 05)b ryry Pork . h 6735fit's /' 711 i ✓ i, m `" 380 • J . ° 7 y � � • vim. '+ t. i p://f!o' • .)°y Yso ' �, � y~ 1 ° o Ufa) t, .,�e • , •R,.� y34 \ti i,l� G71 , ; �,•�/, 6 'S�' n m q� m • z� n.• Biu n : y;) 7 M ff• oe / yRJs•�'�°,• y Hi'' yoo L• J^ I n �� • o Bo Bo'••'Bo 2 0,9� 's� / ,�� • y'' t . IVV h I o) 0 7 1 6 t €� „^�5 �--35 u ^ 491.c 5,09 517 NGI y11 Bl S co I •�,: - ••:. tG' •.l� y` �ot /in o�� 60 t'y� 6� BJ c T� rw Oen J 163581 INSPECTION REPORT CITY OF FRIDLEY MINNESOTA (763) 5712-3604 ADDRESS Off BUILDER DATE /Z--"11 Y n TIME DATE REPORT If no corrections are listed above, approval ireby given to proceeds. You will be in violation of the ordinance if you do not call f r e proper inspections and make corrections as called for. Building BUILDING Permit No.: , -Ir boo Sq Inspections RESIDENTIAL APPLICATION Received By: 763-572=3604° CITY OF FRIDLEY mate Recd: 9I`1 DATE—f[3/09YOUR E-MAIL ADDRESS SITE ADDRESS kfSV c -i owk THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: Gvf� TENANT ADDRESS �C C' CJ V CITY a ) -c' STATE IP M3 V- �^ PHONE: /�– CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE—ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION MAINTENANCE/REPAIR REMODELING DESCRIBE WORK BEING DONE: " (� h rc v SIZE OF IMPROVEMENT U LE GTH WIDTH HEIGHT sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2• Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other . ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.BJC FEE SCHEDULE) TOTArJOB VALUATION $, OCCUPANCY TYPE Permit Fee � .• Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ 83,22 T- $�6t $ c�t1 $ ��— $_ n l $ Al•8� See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach 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 wo wh ch requo review and approval of plans. c SIGNATURE OF APPLIC PRINT NAME \ -,k–� G1� 2� J �V �� DATE 9/x 2 XG,/ cid r. �11 s�, s Old C� - ;z �5 .3 ! occ PIA fe Building MECHANICAL Permit No -0 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY II Date Rec'd: H 1763-502-4977 FAX EFFECTIVE 1-1-08 CO "I (icy- 0 b -MAIL' ADDRESS �� G e u �� u� % �d / DATE PUR SITE ADDRESS �- "" L_L THIS APPLICANT IS: 1&WNER ❑CONTRACTOR PROPERTY OWNER/ NAME: t�Yln 7 / _,,--,,JJ �FQv /�f�y CITY �r STATE /0�6GIP S"sr ADDRESS: TENANT PHONE: CONTRACTOR COMPANY NAME: `z�«'� NOTE: SEPARATE CITY CONTACT PERSON: LICENSES ARE REQUIRED FOR GAS STATE LICENSE # EXP DATE o ✓t STATEIP l�Zl Cgal� o ofa) F° CITY e ofln !�-''% AND HVAC. COPY OF BOND ADDRESS: cJ 2— 2 ` 2V SUBMIT PHONE -3aA-X - AND INSURANCE PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL ESCRIPTION OF WORK PER65 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the FMS nstallation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) OR Labor cost under $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) �j�� MODEL: Z�& X31 SIZE/BTU 36 dUD MFG: jp -- Equipment Installed ! �1�`-"'� �—� MFG: ( MODEL: 7-L "z- SIZEBTU �o MFG: MODEL: SIZE/BTU $25.00 (GAS) $15.00 _GAS RANGE/OVEN $10.00 WAC ,_FIREPLACE _AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 UNIT HTR $10.00 BOILER $35.00 FURNACE $35.00 _GAS CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 VDUCT WORK $10.00 �j GAS PIPING $10.00 VENTILATOR $15.00 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances I this is not a but only an application for a permit and work is not to and codes of the City of Fridley and with a Minn to n ction Codes; that understand permit start without a permit; that the work will b rdanc the approved plan in the case of all work which requires review and approval of plans. PRINT NAME J IM V-3e031-J-1-r DATE 'f_ 14-`9 SIGNATURE OF APPLICANT APPROVED BY DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977