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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: ..... �.rl .. A` I ............ Owner ....................................... Address...................................... N® 3816 Builder �%........ ....... Address..................................... � LOCATION OF BUILDINGNo. Q !� !... Street. ...... rt of Lot ............. .......... Lot .. 4 ...... Block ... !....... .. Addition or Sub-Divisit , .. ..... ... ��Z.. Corner Lot ............ Inside LotSetback-34-:-.'P..�• . .......... Sideyard ��....................... DESCRIPTION OF BUILDING To Used pp . ... ... Front . � Depth/. J..� Height ��'� Sq. Ft... Cu. Ft. R, ......... Front ........ ' •Depth ........ Height .. .. Sq. Ft. ........ CSL Ft. ........ ........... .... Type of Construction ................ Est. cost..,... To be Completed .................... In consideration of the issuance to me of a permit to construct the building desribed 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. I... .::.. ......... w In consideration of thea ent of a fee of permit is hereby ted to P Ym $•��.....� P Y gran ................... ......................... 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. — ... Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building InRaQj&W0&r separate permits for then items. IF APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY.. MINNESOTA Owners, ' Builder Address - - ----- Addresa aQ—® LOCATION OF BUILDING No. - • .• Street t of Lot Lot � Block.. Addition or Sub. Div. Cornet ' Lot.. .. Inside Lot Set Back - Applicant. -attach to this form Certificate of Survey of Let and proposed building. location. . .' u d as �I i� DESCRIPTION OF BUILDING Front �° �._. Depth Height )7_10J Cu. Ft. Front —Depth Height Sq. Ft.,*-;- Cu. Ft. �_._......_. Type of Construction R .. Estimated Cost �.¢.•,—.... To be completed The undersigned hereby makes application for a permit for the work herein'speeified, agreeing to do all work in strict aecordanee with the City Ordinances and ruling of the Department of Buildings# and hereby declarea.that all the facts and representations stated in this application are true and c erect. Date Signature (A Schedule of Fee Costs can be found onRev rse ido) pppp�' � z City of Fridley, Minn.. BUILDING PERMIT Date: - July 9, 1990 Owner: Anton. E- Johnson Builder Same Address 1061 Rice Creek Terrace Address Same LOCATION OF BUILDING No. k 1061 Street Rice Creek Terrace — part of Lot Lot ,_,_,.2 __ Block 1 Addition or Sub -Division _ Brookview Terrace 2nd Corner Lot ._ Inside Lot — X Setback -- Sideyard Sewer Elevation ___ — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Car Port Front 1$' _ Depth 24' Height $off Sq. Ft. cu. Ft. 5`�ro S . 17744. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Metal & Wood Est. Cost $250.00 To be Completed Sept. 1, 1970 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 compl nce, with all provisions of ordinances of the city of Fridley. /A In �/ � 1 In consideration of the payment of a fee of $-L- 00 , permit is hereby granted to A4ton E . Johnson 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 dty ]units and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. A4 6 r HANK MUNICH NOTICE: This permit does not cover the construction, W ta&Mon for wiring, plumbing, gas heating, sewer or water. Bo Baro to we the Building Inspector for separate permits for the items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER 'S NAME 4 n +0 V, � h s a71 ADDRESS /Q (, / 12/"e e- (1/'Z e e K ee 4 ADDRESS LOCATION OF BUILDING NO. / D 6 STREET LOT ' BLOCK I ADDITION OR SUBDIVISION P& 0 o LV CORNER LOT INSIDE LOT +� SETBACK SIDEYARD 4 SEWER ELEVATION TOP OF FOOTING e Y)o (2-" 4 - 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: ?�-n N1n- ! DjZ + Front i Depth -2-Height . 6 Square feet Cubic Feet Front Depth Height Square feet Cubic Feet Type of Construction J - Estimated Cost To Be Completed 7 ro/i? / — 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 representation stated in this appli ation are true and correct. DATE % /f U SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side.) a a JZce�C F- �1 SUBJECT E NO. City of Fridley 1725 1 AT THE TOP OF THE TWINS BUILDING PERMIT r RE '' I �• COMMUNITY DEVELOPMENT DIV. r i PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/19/83 JOB ADDRESS 1061 Rice Creek TerrAce 1 LEGAL LOT NO. BLOCK 1 TRACT OR ADDITION SEE ATTACHED Brookview Terrace 2nd Addition DESCR. 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 1 Rice Creek Terrace 571-2838 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 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 )0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 16' x 16' 3 season OAKUM porch 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. 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 256 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 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 $1,750.00 $8 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 30.38 URE COVT9AIK R HORIZEDAGEN rElEN PROPERL VALYOURMIT BLDG INSP GATE SIGNATURE OF 01 NE OWNER BUILDER) I EI F- �1 CITY OF FRIDLEY APPLICATIQI FOR RESIDENTIAL BUILDING PL VITS (Revi, Alterations, Additions, or Repairs) OWNER: ADDRESS: M 6 / 4 TEL NO: 5-;7/— a 39 STREET NO: / el 10 LOT: Effective Aug. 1, 1981 •BUILDER: "5'AA49 ADDRESS: TEL 110: Construction Location STREET: 7C,s• BLOCK: ADDITION: Corner Lot: Inside Lot: . K Setback: Sideyards: Applicant attach ,to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. �G DESCRIPTIOR OF CO„STRUCTION Front: Depth: Height: Square Feet: e;;? 6��-7 Cubic feet: o� f �- Type of Construction: GLlo®J Estimated Cost: $ '!b Be Cbr.pleted: Alt. A Al t. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE PF.VFR;I.' SIDE OF SHEET . Zile undersigned hereby makes application for a permit for the %:.,ork 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 representltiens stated in this application are true and co;rect. DATE: /Cf190-� SIGNATVI: Stipulations: 6�21�;-O t(/ V y 5- Front: 1,61 Depth: O� Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: e;;? 6��-7 Cubic feet: o� f �- Type of Construction: GLlo®J Estimated Cost: $ '!b Be Cbr.pleted: Alt. A Al t. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE PF.VFR;I.' SIDE OF SHEET . Zile undersigned hereby makes application for a permit for the %:.,ork 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 representltiens stated in this application are true and co;rect. DATE: /Cf190-� SIGNATVI: Stipulations: 6�21�;-O t(/ V y 5- M 01 SUBJECT PERMI City of Fridley 18 8 2 4 AT THE TOP OF THE TWINS BUILDING PERMIT ' ' R • _ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 1 V� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 .3/18/87 JOB ADDRESS 1061 Rice Creek Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 1 Brookview Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John D. Blaha 1061 Rice Creek Terrace N.E. 574-0327 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 X7 NEW ❑ ADDITION [I ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct.a 40' x 24' Detached Garage and Convert Existing 24' x 12' Existing Garage to living area 9 CHANGEQFUSEFROM TO STIPULATIONS Provide a hard surface driveway. II BNG Elg� 0 599in , cald local TELEPHONE Utilities ELECTRIC SEPARATE PERMITSREQUOREI) . GAS Et, By � WIRING, HEATING, REQUIRED FOR P L.UMSING N® SIGNS. 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 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 $7.54 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $15,085 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. $116-50 PLAN CHECK FEE TOTALFEE $124.04 SIG NAT URE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) c• r- WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT ,-- 3 9r147 SLOG )NSP ,ATE iGNATURE OF OWNER(IF OWNER BUILDERI ( ATE) M 01 NEW [ ] City of Fridley Effective 4/1/86 ADDN. R-1 AND R-2 ALTER. Building Permit Application Construction Address: 106Y lf`e_"'e L���ee- h- /-ee-- Legal Description: Z-0 % Z� y�1��� Owner Name &Address: v �� `� '� �I� �a Tel. #� Contractor: Jrej Tel. # Address • i q _=. e -- Attach - 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 Z �iO" Width / Z "�% t Height _. Z Sq. \\//Ft. g8' C f 0. GARAGE AREA: Length `f'O IO �� Width � Height /0� d �� Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [11---�- Ft. Yd. Setback %I)17M%t YO Side Yard Setback 7,6 Type •- Type of Construction: fr"gEstimated Cost: $ 71910 Approx. Completion Date: Alt. A Alt B 0 Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: 5 9g7 APPLICANT: Tel. CITY USE ONLY Permit Feed Plan Check State Surchar e SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side 25$ of Building Permit Fee $.50/$1,000 Valuation $ 525 per SAC Unit Fee Determined by Engineering 20o Agreement Necessary [ ] Not Necessary [ ] G�( 54-1 ,ja d -y I 71k,ox' so ENGN I. -RING INC. S-91-7 cill? cc, 1--51 t, of sa"ove AW 91 ver 95- ,:M4 x said lmd, A o,,,/ r, :q" or FOR Aip,"4 g -16' -97 F, SUBJECT PER City of Fridley'20459 AT THE TOP OF THE TWINS BUILDING PERMIT � COMMUNITY DEVELOPMENT DIV. 6 _ PROTECTIVE INSPECTION SEC. 1' I® CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910415 7/3/90 JOB ADDRESS 1061 Rice Creek Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Brookview Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE 574-0327 John Blaha 1061 Rice Creek Terrace N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. XX 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 )p REMOVE 8 DESCRIBE WORK Remove enclosed porch at rear of house 9 CHANGE OF USE FROM TO STIPULATIONS Clean all construction debris from site. 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 60 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 I 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 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $100 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- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $15.50 SIG IATUREOFCONTRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERLY TED THI IS YOUR PERMIT 7-3 VD SIGNATURE OF OWNER of OWNER BUILDER$ IDATEI °+ BLDG INSP �� E F, NEW [ ] Effective 1/1/90 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: Le�'�"c-e���-- legal Description: 1-eT AlG-k I Owner Name & Address: s /d 1�4 91eT be -1- Tel. Contractor: lvat7 e Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVIPG AREA: length Width Height Sq. Ft. GARAGE AREA: length Width Height Sq. Ft. DECK AREA: length Width Hgt/Ground Sq. Ft. Corner Int [ ] Inside lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: Proposed Driveway Width If New Opening Is Desired: Ft. $ $ / Width + 6' See Back Page DA'L'E: 2- ?7 - � APPLICANT: 1)&,/7 �, P 91�, !�7� Tel. # Permit Fee $ n U State Surcharge SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ STIPUTATIONS: 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 [ ] Not Necessary [ J i IK� ll, 1996 Fr-,c1lo�� Y�IJ 5S43Z x.5473 1 SUBJECT PE City of Fridley 3 362 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. ______ r � PROTECTIVE INSPECTION SEC. 1 . � NUMBER REV DATE PAGE Oi APPROVED BY 1 = r"'I CITY HALL FRIDLEY 55432 �'� 612-571-3450 91Q-Ft5 12/17/01 JOB ADDRESS 1061 Rice Creek Terrace NE, I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Brookview Terrace 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Marty Johnson 1061 Rice Creek Terrace NE 763-574-7344 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Frontier Home Exteriors 106 Peninsula Rd, Medicine Lake MN 55441 763-545-3333 d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 20171644 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION j] REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (24 Square) Tear -off 9 CHANGEOFUSEFROM 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 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 VALIDATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,573 $1.29 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION Alwl/� PLAN CHECK FEE TOTA EE Licens $5. $ .11 S-GNATURE OF CON! PAC:T<50 R UTHORIZEO AGENT DATE; HEN ROP Y VALIDATED .HIS IS Y UR PERMIT $,GNATURE OF OWNER,IF OWNER BUILDERI iDATE, BL .NSP ' rA1E 1 NEW [J ADDN [ J CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Effective 1/1%1001 ,(763) 572-3604 Bldg Insp Legal Description: /a 6 / Q t CC- C (- - �1 g Owner Name & Address: 11114(1-611,l o Wrwv Tel. # %G 3 —S7y-7--,P-,- Contractor: c►n► 7 /�a�� C=�7raC�s MN LICENSE # Zc� 1 7 / y se ®G EN( i10S ��i 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 Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground . Sq. Ft. OTHER: Construction Type: V-�av� Estimated Cost: $Is, s -3v- CID .95 73 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE:/7 vi APPLICANT: Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ 93,c9 Fee Schedule on Reverse Side Fire Surcharge $ —7 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ 6:,00 $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 S STIPULATIONS: