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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: Owner: Builder Address l r, N° 5119 ICAI®N OF BUILDING No. Sixeet Lot _ _ .__ Block _.-- ,Addition or Sub -Division , _. A_� Corner Lot .._._......_+.._ Inside Lot � Setback�....__...... Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING ' Zo"d Front _ Depth Height dqO Sq. Ft. -AO-QL Ft. Front _ Depth Hpight _ ___ Sq. Ft. _. Cu. Ft. Type of Construction Fist. Cost _To 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. r In consideration of the payment of a fee of SA'" 1 , 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 time upon violation -V any of the provisions of said ordinances. 1 A A %' Building Inspector NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be ire to see the Building Inspector for separate permits for these items. 4 APPLICATION FOR BUILDING PERU CITY OF FRIDLEY, KMWESOTA Owner's Name Builder��� ° p Address Address®,� �e— LOCATION OF BUILDING No. �IL Street of Lot Lot Block ` Addition or SubdivisionAi,_O� ` Corner Lot _,______•Inside Lot P Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of.Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING Haight Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be Completed The undersigned hereby makes applidation'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. (A Schedule of.Fee Costs can be found on the Reverse Side.) .V City of Fridley, NUnn. BURDING PERIMT N? .7 -143 ownsr-6z/er .Address . I� L ON OF UILDING No. Street V Part of Lot Lot _ _ __ Block Addition or Sub -Di on Corner Lot Inside Lot _� Shack Sideyard Sewer Elevation Fo dation Elevation DESCRIPTION OF BUILDING fb Lfi ed as: o Front 2L. Depth A Height _oel!_ Sq. Ft.Cu. Ft,� Front _ _ Depth -5k Height Sq. Ft ��Cu. r T� Type of Constructionk= = �� � Fit '°—"'.. To 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 ilA compliance with all provisions of ordinances of the city of Fridley. A /J 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 time upon violation of any of the provisions of said ordinances. NOTICE: Sle permit dew not cover the construction, Indanstion for w►him& piumbing, gas he&&& sewer or water. Be am to see the Building Inspector for separate permits for these trams. 7 4PPL.XCATTON 0011 BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA e OWNER'S NAW/ -)),a ��„ BUtLbER 11M ���� a f 3 f�_' a"CL tl k_s� ADDRESS _L0 r ADDRESS LOCATION OF BUILDING Noee'er C� streete 1�*eta �=� Part of Lot Lot ":Block.. Addition or. Subdivision Corner Lot Inside Lot4--Setback Side -Yazd SEWER ELEVATION FOUNDATION ELEVATION Appll-cant.attach to this form Two Certificates of.Survey of -Lot and proposed build- ing.location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: (� Front Depth Height Sq, Ft. Cu. Ft.� w P0, Lee Front Depth' Height Sq. Ft'* f Cu ..Ft Type of Construction' r 2,4e , Estimated Cost G . 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 that all the facts and representations stated in this application are true and correct. MR9, jSchedule of Fee Costs can be found on the Reverse Side). SUBJECT PERMIT__ Q ..._._ City ®f Fridley � 2 2 613 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. 1s PROTECTIVE INSPECTION SEC. r NUMBER REV. DATE PAGE OF APPROVED BY ���,`, CITY HALL FRIDLEY 55432 i •-_. s 612-571-3450 910-F15 6/15/94 JOB ADDRESS 860 Rice CReek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 4 SHEET Brookv e 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Timothy A. Brockman 860 Rice Creek Terrace NE 571-2579 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 ❑ NEW ❑X ADDITION 1:1ALTERATION [IREPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 24' x 9' and 14' x 7' Deck 314 sf 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide smoke detectors adjacent to all sleeping areas and in basement. WARNING Before digging call for all utility locations 454.0002 REQUIRED 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 NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $2,559 $1.30 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- $54.00 Fire SC $2.56 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. . PLAN CHECK FEE TOTAL FEE $57.86 S NTUBE OF -0TTRAC ORO AUT RIZED AGENT (DATEI WHEN PROPER VALID TED THIS IS YOUR PERMIT m `BLO )NSR riAT • SiGNATUR F OWNER OF OWNER BUILDER) IDATEI NEW Effective 1 / 1 /94 ADDN CITY OF FRIDLEY ALTER (J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application 7, Construction Address: U0 Legal Description: Owner Name & Addres Tel. # 571- 2-5 i 5 Contractor: <e,' 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 II, LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width �j Height Sq. Ft. DECK AREA: Length �� Width Hgt/Ground Sq. Ft. ' �s,'x- OTHER: e' G Y, ~Z 11'X 1 q , Z b " W ; ��- 3(o Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks 5 /tog Type of Construction: �A66D Estimated Cost: $ X 00 Approx. Completion Date: �r o Vl X R9 q (Cost on Back) Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: `'tS'`l `] APPLICANT: r Tel. # `71 2 5 -75 CITY USE ONLY Permit Fee $ f �/, '1`' Fee Schedule on Reverse Side Fire. Surcharge $o Io .001 of Permit Valuation (1/10th%) State Surcharge $ _ 4- 1,30 $.50/$1,000 Valuation SAC Charge $ $800 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: SUBJECT City ®f Fraley 2 5 4 5 7 AT THE TOP OF THE TWINS g U I L D I N G P E M I T rp RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 3q 1 NUMBER REY DATE 9/3/97 PAGE Of APPROVED BY 1 CITY HALL FRIDLEY 55432 ti----11.� �'' 612-571-3450 910-F15 JOB ADDRESS 860 RICE CREEK TERRACE NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 4 4 Brookview Terrace 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS. ZIP PHONE Tim Brachman 860 Rice Creek Terrace NE 571-2575 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Steven Woods Construction 6830 Beard Ave N, Brooklyn Center, MN 55429 6810 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 537-2664 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (23 Sq) Tear-off 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 SQ. 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 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 $1,918 $.96 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- $62.25 Fire SC $1.92 STRUCTION OR THE PERFORMAN E OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5.00 $70.13 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI NHEN PROPERLY VA,4DATED THIS IS YOUR PERMIT BLDG NSP ' IIt GATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R -I AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: D KR1.U— CAe-eK.TZ&'\--UC--�— Legal Description: 1 fly re -5 l Owner Name & Address: VT1 M 6Aa m ;7 �i Tel. #'5 -7/,2 -S7 -5 - Contractor: '5 -7/'2S75 - Contractor: J -W01 �Jy o �—s c6uJA Vebott MN LICENSE # (019 /19 Address: !�403lq Iseg-rd- Avg 0 Tel.# 00 6-3-7_9��o�! 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 S . Ft OTHER: " t-e4k 6yu=&�c Construction Type:_ � Estimated Cost: $_,���-~�` (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE:L APPLICANT: c� Tel. #,.537 4 L STIPULATIONS: CITY USE ONLY Permit Fee $- Fee Schedule on Reverse Side Fire Surcharge $ f> .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 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: PLUMBING RESIDENTIAL APPLICATION City of Fridley Permit N ber Re ved B d Ddfe RecpTved NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE o ®s— YOUR E -M L ADDRESS SITE ADDRESS d'e- THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRALTO NAME Aniiela- PROPERTY OWNERI ADDRESS S TENANT CITY STATE ZIP S 1-731 PHONE # NAMEH.P. ®e r9 LICENSE # Z rr a .. , ADDRESS 36M DODD9 CONTRACTOR '-"T CITYN, MN ss i m _STATE ZIP PHONE # ( ') 134.0 FAX# PERMIT TYPE SINGLE FAMILY —TWO-FAMILY TOWNHOUSE TYPE OF WORK ❑ NEW REPLACEMENT 10. CC DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Need City license) SWIMMING POOL WATER SOFTENER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY WATER HTR ($35) FOR IRRIGATION WATER METER OTHER Permit Fee $ MINIMUM: $15:00 or 5% of cost of the Improvement -whichever Is Plan Review $ greater on work less than $300 Surcharge $ .50 TOTAL DUE $ —, .5 Make checks payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT - NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 work which requires review and approval of plans. NAME OF APPLICANT r), DATE i9 ' �� s6 3- Pleahe typ print SIGNATURE OF APPLICANT C 7 x 77 i `'LA�-t^,. CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT 6431 UNIVESITY,AVENUE NE, FRIDLEY, MN 55432 (763) 572-3604 ' �(� kD Permit Na.: Building MECHANICAL' Received By: Inspections RESIDENTIA.Il APPLICATIO Date Rec'd:_ 7.63-572-3604 CTTY OF FRIDLEY DATE , YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: 0 OWNER ONTRACTOR PROPERTY OWNER/ TENANT cONTRA.CTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: CITY -EA *STAT4j&—)ZIP—SS11?-- PHONE: `, '1 f COMPANY NAME: PION f HEM KEA . %A '(W CONTACT PERSON: STATE LICENSE #_ EXP DATE P- PHONE'1�@�J' � . 1� FAX w ETSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE p NEW REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK 0, whichever is greater, for the reso (Thi Should reflect my the cost of labor ) PER MS 16B.665 the permit fee is a minimum of$15.00 o� e�ez lud ng the fxUP improvement, installation or replacement of a residential Labor cost under $300 = $15.00. Labor x.05= cost between $300 to $500 =cost of labor—x.05 WHERE LABOR EXCEEDS $500, FEES ARE BASED ON SIO -00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL FOR PROJECTS NUMBER OF EACH BELOW) MODEL: G SIZE/BTU SIZE/BTU Equipmentln W1td MFG: MFG: MODEL: % 9AI—.0---744 SIZE/BTU MFG. MODEL:�— FIREPLACE {GAS) $15.00 GAS KANGE/OVEN $10.00 5.00 NEW GAS GRILL $10.00 J, A/C $25.00 AIR TO AIR EXCHANGEER $15 (WOOD) —FIREPLACE {WOOD) FIREPLACEGAS UNIT HTR $10.00 5.0.00 —POOL HEATER $35.00 - BOILER $35.00 CHIMNEY LINER $IO.OD —Gp�s DRYER — VENTILATOR $15.00 PIPING $10-00- — DUCT WORK $10.00—GAS RMWE € Number of fixtures @ $10.00 x $10.00= $ Permit Fee $ P PermitSurcharge Number of fixtures @ $15.00 x $15.00 = $ $ 50 Number of fixtures @ $25.00 �_ x $25.00 = $ TOTAL DUE $ Number of fixtures @ $35.00 �_ x $35.00 = $ State Surcharge = $ .50 Total = $00 V 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 d this is conformance with the ordinances and codes of the City work�slnot o start with withoutapermit; that the work will be inesota -construction Codes; that accordeanc�e with the not a permit but only an application for a permit and � / l approved plan in the case of all *rk which r1q> essr view and approval of plans. pn �A* I naTF !//, SIGNATURE OF APPLICANT city of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, NIN 55432 763-572-3604 Building BUILDING Permit No.MUOO Inspections RESIDENTIAL APPLICATION Received B 763-572-3604 JUL 08 CITY OF FRIDLEY DateRWQP 763-502-4977 FAX EFFECTIVE I-1-09 DATE %—- (J YOUR E-MAIL ADDRESS `�Blr>i1. Dl � r�ir/i�e <J✓h SITE ADDRESS 96; d /i'/ c e 621 -eel- Y-e4nn C gv ��e4 41A) S Z%3 a� THIS APPLICANT IS: ,EI OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: rale -1, TENANT ADDRESS: CITY FIill �z STAT&A& ZIPZ- PHONE: CONTRACTOR NAME: SUBMHT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE 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 ❑ DECK ,®'SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION I'0MAINTENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR. NEW CONSTRUCTION INCLUDING DECKS, IDING-- Vinyl 13Soffit ADDITIONS &PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 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 1I9)9�/7 ^U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ O n 0 M'�.// 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 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) $2000 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$22=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks oavable to: Citv of Fridlev 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 on site; that the work will be in accordance with the approved plan in the case of all work which regqu view and approval of plans. SIGNATURE OF APPLICANT /v PRINT NAME /MSL 614 A6115 C 14 DATE 1-F-497 $ �Q $ 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) $2000 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$22=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks oavable to: Citv of Fridlev 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 on site; that the work will be in accordance with the approved plan in the case of all work which regqu view and approval of plans. SIGNATURE OF APPLICANT /v PRINT NAME /MSL 614 A6115 C 14 DATE 1-F-497