PRE 2010 DOCSCity of Fridley, Milan..
6431 University Ave. N. E'�., Minneapolis, Minn. 55432
BUINV' PERMIT
Date: August 18, 1972
Owner; Leif Henricksen Builder
Same
495 Mississippi St. N;E, aame
Address �............__...._._ Address
LOCATION OF BUILDING
No.6456 _ Stzeet Riverview Terrace NE;, part of Lot f
Lot part of Lolmock 1-4.__ r __ _ Addition or Sub -Division Ai+ i tar's S rb i yi si on All
t de Lot Setback Sideyard
c t7to�___ ` Elevation of W e 82 399
41 N. of M:H: y .
Sewer Elevation _ Foundation Elevation _.._
Top of Footing 831.39 (Approx) ja1fer Loca:ipia 58' from M:Hs„______ :13-4
_® ,
To be Used as:
Dwelling Front 46 Depth 29 Height 20 Sq. Ft. Cu. Ft.
_. .� ...._....__ Front 22 Depth 24 Height _ 10 Sq, Ft, 528 Cu. Ft 5,280
Type of Construction Frame Est. Cost 23,465 . Y To be Completed 1 year
1. Provide verification.Survey
2. Check basement design with building inspector before pouring footings.
3. Provide a hard surface driveway.
XU consideration of the issuance to me of a permit to construct the building
the proposed work in accordance with the description above set t d iu ccs
ordinances of the city of Fridley.
I agree to do
provisions of
Xn consideration of the payment of a fee of $ 56.00 , permit is hereby granted to Lief Hendriksen
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 BE work
done in, around and upon said building, or any part thereof, shall conform in all respects -to the ordingnces of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buil
Within the city limits and this permit may be revoked at any time upon violation of any of the provisions of aa d
ordinances. 014—
Building Inspector
NOTICE:
This permit does not cover the construction, installation for whing, plumbing, Bas heating, sewer or grater. Be sure to sea
the Building inspector for separate permits for these items.
a
oc :
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PgRMIT
CITY Q,F FRIDLEY, MINNESOTA
OWMS NAM :�i';- " , �i � BUILDER:
ADDRESS: /4-;,�'� ADDRESS:
NO:: °` STREET:__;
LOT; K . ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDo
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:
Square Feet: Cubic Feet:
4,
Front: Depth: Height:
Square Feet;Cubic Feet:
Type of Construction: ' -4' Estimated Cost: $
To Be Completed:
The undersigned hereby makes application for a permit for the -work herein
specified, agreeing to do all work in ettict accordance with the City cf
Fridley Ordinances and rulings of the Department of Buildings, and hexebT
declasses that all the facts and representations stated in this applic4tion.
are true and correct.
DATE:
(See Reverse Side For
SIGNATURE:
Additional Information.)
f'
P
i
.an�Plonnm� ._ . 6B%S-f/r9 nay S
tmdsli
�r SO4 leflrn9 ENGIN
:� E R I N v� INC. AfinniCSO/u
Civil b Mmkipvl SUnsciQ 6066
hyneermy -=- Fn ineers Surveyors.
ell"
• f �e of ���' ' �- -�'' --�''� . • . . - - ..
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That part of Lot 14 Revised Auditors Subdivision No. 23 Anoka Co., Minn. described as begin-
ning at a point on the Southerly line of said Lot 14 distant 130.11 feet Southwesterly of
the Southeasterly corner of said Lot 14; thence Northerly on.a line if extended would inter-
sect the Northerly line of Lot 13 of said Revised Auditors Subdivision at a point which is
;84.08 feet Southwesterly of the Northeasterly corner of said Lot 13, to its intersection wit}
the Northerly line of said Lot 14; thence Southwesterly along,. said }northerly lice of said
Lot 14 for a distance of 133.15 feet; thence Southeasterly to a point in the said Southerly
line of Lot 14 distance 110.15 -feet Southwesterly of .the point of beginning; thence North
easterly to the point of beginning. Subject to an easement for driveway purposes over South-
erly 15 feet thereof and an easenent for road purposes over the Easterly 20 feet of the abov
describ sgdractl.„
l here y err ,fy f`Tot /ti,s ,s o Inje m d Gf rrlr� s+rnlvtnsn .�e sxyeq "r bw-d1.r;es abo.r c uribed !orrd, 4-A1r J L
.yr hwhnt''v,:' i a,Lu:-4js,f.'rrrm, 4'fal M'V/ le f vwchmen! ,JrO . ran I oI'm fm a I t A su�'vt�/cd bjme 1�%
.4.n SUBURBAN ENGINEEPING, INC.
In ineers f1' 5wreyvr5
AY
:-r-10
'; 1 -
cation ftW Pourer Phots and Heatift COOlinngR Yenhlafte. Re%igeovWIon and
Air CORMOning System and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: MTN TOTAL
Furnace Shell & Duct Work ... ..... I ...... .. $10.00 $
Replacement of Furnace .... . ..... ..... . 6.00 $
Repairs & Alterations—up to $500.00 6.00 $-- - --_--
Repairs & Alterations each add. $500.00 3.00
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ......
. ..$10.00 $
each add 60,000 BTU ....................
.. 3.00 i
Replacement of Furnace .. .... I ..
.... 6.00 $
Repairs & Alterations—up to $500.00
6.00 $
Repairs & Alterations each add. $500.00 .... ..
&00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $.
Furnace Shell & Line --to 640 sq, ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam 3.0n
Each add. 320 sq. ft. EDR Hot Water 3,00 $^._
OIL BURNER—to 3 gal. per, hour
6.A0
$ _
over 3 gal. per hour—See Fee Schedule
GASB (up to ,000 BTU)
5.00
$
over 199,000 BTU See Fes Schedule
GAS FITTING FEES:
NO RATE 'TOTAL
1st 3 Fixtures .....
x$ 7.W
$
Additional Fixtures
x .95
$
Gas Range to 199,000
X$ 5.00
$
AIR C014DM0NU#G
$
FAN HEATING SYSTEM see Fee Schadaw
YITILATWG SYSTEM$
ALTERATIONS & REPAIRS
TOTAL FEE
$
ROUGH
FINAI.v� ®� v 7 •�
(SURCHARGE $_,50)
Dept. of Bldgo. Phone 680-3M
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordifnaucei
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Kind of
Used as
To be completed about
Estimated Cost,
Permit No,
hermit No.�%
HEATING or POWE1iJPT.AN15--��beaah. Hot Water, Warm Air—No
7
011
BURNER — Trade Name Size NO
Capacity Sq. Ft. ED -R BTU
(REMARKS -OYER)
S1MR3AN AIR CONDITI®Null; GD,
BY 8419 CENTFQ Mur
'"INNEAAE®LI,S. MINNESOTA 55431
Business Phare No
1
c P cglazQ:o,-anga
c
Air°$ ,3wDo-dew
PARTIAL RATE SCHEDULE n8pt. of Bldg i
GRA`19M WARE AM:
RATE THAI.
P%nmace SbelI & Duc4 Worts ...
..... . $10.00
Replacement of rurnace
6.00
Repairs & Alterations—up to 3500.00
&00
Repairs & Alterations each add. $500.0.0
3 tp0 1k
6IL VIAM ASF?
Furnace Shell & Duct Worcs to 120,000 BTU
each add. 60,00.0 BTU . .. ......
Replacement of Furnace
Repairs & Alterations --up to 3500.00
Repairs & Alterations each add. X500.00
STEAM oa HOT WATT SYSTEM
�Of:V:Ildley. '
tips s1 hereby makes application for a permit for the work Pierer
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 f
and representations stated in this application are true and correct.
Fridley, Agan—
X10.00 Owner `ted
3.t�T 3
6.00 @ Kind of Building
6.� Used as
3.00
Furnace Shell do Lines—to 400 sq. ft. FDR Steam $10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $'
Each add 200 sq. ft. EDR Steam A.OQI
Each add. 320 sq. ft. EDR Hot Water 3.00 _
OIL i6URNLFt—to 3 gal. per hour 6.001 $._��
over 3 gal. per hour—See Fee Schedule
OAS l VRIMR (UP to 110110 BTU)
&00
;
over 199,0W = Zoe Fee Schedule
GAS FITTING .
NO RATE TOTAL
1st 3 Fixtures
x8 7.00
3_®
Additional Fixtures
x .75
i-
State
Surcharge
.50�
AIR Iia OMMG
"110 ffi�ffi l Fie
TMG SYS
S—
ALTZA&7TONS & REPAM
TOTAL FM
a
rmL 3 — a 6-- 7J- �
To be completed about. Z � j
Estimated Cost, $
Old --New. Building Permit No. P®rmit No. U
Capacity 5i—Ft ED BT T --- mt
dtAaaas—®mit
st f V11*1IR
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571-3450
December 95 1976
` Mr. Nels Johnson
6456 Riverview Terrace
"-_Fi�idley, MN 55432
Re: Warning Sign Placement
Dear Mr. Johnson:
Your request to Mr. Sobiech, Director of Public Works,
requesting the relocation*of the recently installed
advisory/warning sign near your residence, was forwarded
to the Engineering Division for review.
The City of Fridley has entered into a federally funded
city-wide sign replacement program -with the Minnesota
Department of Transportation. The location, size, shape,
and notation needs were surveyed by a private traffic
consultant, reviewed by our Public Works Department and
approved by the Department of Transportation for in-
stallation. All signs placed must conform to the "Manual
of Uniform Traffic Control Standards"to ensure
Federal participation in the program.
With the above information in mind, we have reviewed
the location of the newly installed warning sign and have
determined that to relocate it from your north -pro-
perty line to your south property line would not give
sufficient advance warning of the approaching curve and
recommended speed. The limited discretion the. City does
have in its location of signs was used to place this
sign on the common property line to the north.
Therefore, I regret to inform you that this sign
cannot be relocated per your request.
Sincerely,
Thomas A. Colbert, P.E.
Assistant City Engineer
TAC; jm
cc: R.N. Sobiech, Public Works Director
Q57,OVUT104,
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DATE:. # -
SIGNED
CASCADE® L1 -C2375 PRINTED IN U.S.A.
I
SUBJECT
City of Fridley
IM44__
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
_
v PROTECTIVE INSPECTION SEC.
7
CITY HALL FRIDLEY 55432
NUMBER
REVGATE
PAGE Of
APPROVED BY
612-571-3450
910-F15
7/21/94
JOB ADDRESS 6456 Riverview Ter NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
Part Of J4
Auditor's SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Nels Johnson 6456 Riverview Ter NE 571-2812
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 ❑ REMOVE
8 DESCRIBE WORK
Install new size back door; install alcove in patio door opening
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED 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
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
ISTALLS I 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
$2,000
$1.00
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-
$45.00
Fire SIC $2.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$48.00
CO TRACTOR OR AUTHORIZED AGENT IDATEI
.WHEN ER _VALIDATED THIS IS YOUR PERMIT
�
aTURI
�Pj�ROP
z
ATURE OF OWNER IIF OWNER BUILDER) IDATEI
BAG INSP GATE
I
NEW ([ Effective 1/1 /94
ADDN ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2� 5
Building Permit Application
Construction Address:v I\. 1 u e'e Ui a � 1 2�. _
Legal Description:
Owner Name & Address: QJ6 LS iy6RJ16,- 7--,9 Tel. # 1�'
Contractor:ii1 �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
$ S �
LIVING AREA: Length"
Width
Height
Sq. Ft.
GARAGE AREA: Length
Width
Height .
Sq. Ft.
DECK AREA: Length
Width
Hgt/Ground
Sq. Ft.
OTHER: I t1STA Z -L D [ f
ER60f S t 7-6 I?f}eK
boot2 . N 1J5TALL
A L,�foNi 1 A)
P®9'T110 DOOR
6)pL1U4�&
$
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: KeS Estimated Cost: $ -' Oo.C,a OD
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: "1- 1 APPLICANT: � � ,�,�, P ((��� l Tel. # J$S- d - q-] a
i
CITY USE ONLY,
Permit Fee
$ S �
Fee Schedule on Reverse Side
Fire Surcharge
$
CC Y
.001 of Permit Valuation (1/10th%)
State Surcharge
$
6' 6
$.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 [
, (V
TOTAL
$
STIPULATIONS:
-
City ®f Fridley
SUBJECT
(
25342
AT THE TOP OF THE TWINS
BUILDING
PERMIT
I
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
8/4/97
JOB ADDRESS 6456 Riverview Terrace NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Pt 14
Auditor's Sub. #23
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Nels Johnson 6456 Riverview Terrace NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Richard Hastings Contr. 6331 Riverview Ter NE, Fridley, MN 55432 574-9966
4 ARCHITECT OR*DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
4051
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION IR REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (26 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 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 I 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
$2,164
$1.08
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.
n
PLAN CHECK FEE
TOTA E
Lic s e
$5 83.00
SIGNATURE OF CONTRACTOR ORA HOR12EDAGENT (DATE)
EN R
VALIDAT D HIS IS YOUR PERMI
Wt�BLOG INSD
rfA7E
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/97
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 7J0 K
Legal Description:.
Owner Name & Address:
Tel. #
Contractor: � �, Ll> 4A 5 �ti N C S MN LICENSE #
Address: j i iZ ` L) S p 0 i ,t;- L,_, � t2 Tel. # S-7 y — F
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:
x. 46 s f 4- Ar -
Construction Type: ` rE-,4 jz c p j=
Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft -x $ _ $
DATE: 7 APPLICANT: 4 �/-L Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ 9L/ 99— Fee Schedule on Reverse Side
$ , l .001 of Permit Valuation (1/10th%)
$_ l• �� $.50/$1,000 Valuation
$ $950 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ 63. on
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ J
Building
PLUMBING
Permit No.•
Inspections
RESIDENTIAL APPLICATION
Received By*
763-572-3604
CITY OF FRIDLEY
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS I Lle �•
THIS APPLICANT IS: O OWNER ONTRACTOR
PROPERTY
NAME: (' Von
ADDRESS: P ! STAZ
OWNER/
TENANT
PHONE:
CONTRACTOR
NAME: r
STATE LICENSE #,0/-?429; _ 1 P� DATE �� - � / " (�►
g 4 / D LnCrl Y
SUBMIT A COPY OF
YOUR STATE
ADDRESS: f C�i ts4� / e_STATENI�ZII'-
LICENSE WITH
PKONE7(D 3 ti DO —� r�� FAx _LI ---&U9 %C?
APPLICATION
-
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
' REPLACEMENT
DETAILED DESCRIPTION OF WORK U)a a i, So-pie e r
PER 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 under $300 = $15.00. Labor cast 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 _FLOOR DRAWS —SHOWER WATER SO NCT
GAS PIPING SWIMMING POOL WATER FTNER ($35)
—BATHTUB _ (NEw m7Lrcm) _
CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15)
_
— DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
— — _ WATER METER — OTHER
PERMIT FEE PROJECTS FOR UNDER $500
PERMIT FEE FOR PROJECTS OVER $500
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 $ .
State Surcharge = $ .50
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 ofs aallwork which requires review and approval o£plans.
SIGNATURE OF APPLICANT a�► &�lw ad- PRIIVT NAME ja n r los es DATE bs
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977