`Village of Fridley, Minn.
BUILDING PERMIT
° 1850
Date: ... ............ � �.�' ....�'`� ...... .
Owner....................................... Builder :...'
Address ...................................... Address ....7.`''.....
LOCATIO F BUILDING
No. s�. Street ....A'.,9.2;, �� .: .... d............ Part of Lot .............................
Lot ........ .... Block .......... ..... Addition or Sub -Division ..... VF/ t. S .......
.............
Corner Lot ........... Inside Lot .. Setback•�..�ide and.. ! .' ....... .
DESCRIPTION OF BUILDING
To be Used as: �r
............ Front p .0 . Depth . Ar.? : Height .4� ... � Sq. Ft. ........ Cu. Ft. ........
..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction 4f�. :.... Fst. Cost ... r ..`.. ........... 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 village of Fridley.
r v
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 with-
in the village 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 Inspector for separate permits for these items.
F;
City of Fridley, Minn.
BUILDING PERMIT N® 3090
Date: ... ... 11E� ..........
owner Builder ..............
Address Address .... . . ....................
49 LOCATI" OF BUILDING
No. Street .0 * C '�. .............. Part of Lot
Lot ...... Block ............. . Addition or Sub -Division
Comer Lot ............ Inside Lot ............ SetbackA44-f-ja Sideyard
I DESCRIPTION OF BUILDING
To be Used as:
.. . . .... ..... Front .92�% Depth �/ ... Height ........ Sq. FtCu Ft. ........
................
Fr)pnt ........ Depth ........ / HeigJ31- ..,,* ... Sq. Ft. ........ Cu. Ft. ........
Type of Construction . .........
'VAO.-A 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.
0, 0
In consideration of the payment of a fee of 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 with-
in the city 'limits and this permit may be revoked at any time upon violation of the provisions of said
ordinances., Al -19
_-_;p A � -
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, l g, gas heating,
p70W
sewer or',water. ,water. Be sure to see the Building Inspector for separate permits for these 4 MS.
Application for Power Plants and Healing, Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE TOTAL
Furnace Shell & Duct Work ...........................
$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 $
Replacement of Furnace ............................. 6.00 1.-1--06)
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 3.00 $
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 ...................... 3.00 $
Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $
OIL BURNER—to 3 gal. per hour ........................ 6.00 $
over 3 gal, per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU) ....................... 5.00 $
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x$ 2.00 $
Additional Fixtures x .75 $
Gas Range to 199,000 ........... x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
$
See Fee Schedule
$
TOTAL FEE ! �-
Dept. of Bldge. Phone SM -3450
Location%
City of Fridley:
The undersigned hereby makes application for a permit for the work hereir,
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.
Fridley, Minn
Owner g .
Kind of Building�,e2
,,s 'e
Used as
To be completed about // -f_'S7__ 6 7
Estimated Cost, $
Old New. Building Permit No. Permit No.
DESCRIPTION OF WORN
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name �1 Size No-
Capacity
o Capacity 94wey Sq. Ft. E.D.R BTU /� o H.P.
Total Connected Load Kind of Fue
BURNER —Trade Name _ Size No
Capacity. Sq. Ft. E.D.R I BTU H.P.
(REMARKS—OVER)
Signe.
.
00.9,'@0. 42 Phone
3200 FRANCE AVE. S0.
3rd. STREET N.E.
14 7513 13 76 75
402 .1292.2 AL4 2 49! 2 42!N %, 494876
4940 14
I f24 h9�+
W•
li
p
pp Q h
242 i '�. 14 IS 16 I7 18 19 20
�, o.•j�. spa; +;w E,,9.,rw�t _ � _ '�`_I I W
p g + L Z
2— -� W
10 9 8 7 6 5 4 -
---------
_ P. 40z b I w N
24.2 I 4za
S 2 y !4L
nJ N N
s to N N ' v 40 ee N J ,0 4 3 ry 9 494 a N a
a p II 4 4977 a i 1• 492! ro 4917 ro
i 4 ~ 1.- 7 L'
N4I
JL
41 ry { 242 "
ri K76 1'J if ixi/
13 •, +---
J I jV ,
ROMAN
ROAD
I hereby certify that the above Is a survey of Lots One (1) through Twenty (20). Block
Three (5)..CAAL30N'1-91t41aT MANOR SOUTH ADDITION, Anoka County. Minnesota. shoving the
losation of the houses on said lots.
As surveyed by me this 18th day of April 1955 A. V.
signed
Niwwecoea F+9gintre*ion No. 1584
,i
_a
SUBJECT
715
PE -
City of Fridley
NO 170 2
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RE PT N
COMMUNITY DEVELOPMENT DIV.
f PROTECTIVE INSPECTION SEC.
1 ; e
,`j CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
I
6/9/83
JOB ADDRESS 4953 ROman Road N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
3
1 Carlson's Summit Manor South Addn. SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
C. W. Sandwold 4953 Roman Road N.E. 572-8679
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
H
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
OX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE REMOVE .
8 DESCRIBE WORK
Construct a 40' x 24' Garage and Remove Existing Garage from Property
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface.driveway.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
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
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
I
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
$10252
$5.13
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 STATrn OR LOCAL LAW REGULATING CON-
$ 86.50
S CTI OR THE OF NSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
IA��
$91.63RL
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
ALIDATED THIS
WHEN PROPEIS YOUR PERMIT
l �
- BLDG INSP OAT
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) F
CITY OF FRIDLCY . Effective Aug. 1, 1981
APPLICATIM FOR RESIDENTIAL BUILDING PER111iITS
(Herr, Alterations, Additions, or Repairs)
OWNER: ., '� D' Wo L D BUILDER: D -�
ADDRESS: j D //`� /►/ ,P. ADDRESS: / e ,/L/g7
TEL NO: 7f TEL NO: 7 e --d
Construction Location
STREET NO: -5 /� STREET://� Q %`�C /�' /C ® !
LOT: BLOCK: 3 ADDITION: ZWI Mi '
Corner Lot: Inside Lot: Setback.: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: --- Depth:` Height: T
Square Feet: Cubic Feet: 'ro
S�7— Front: _
Square Feet:
Type of Construction: A /,,4 g -
Rb Be Mrapleted:
Depth: Height:
Cubic Feet:
Proposed Driveway Width If New Opening Is Desired:
Estimated Cost: $
Alt. A Alt. B
SEE FEVER: E SIDE OF SHEET .
Ilie 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 De1xirt3nent of Buildings, and hereby declares that all the facts and
representations stated in this applicz
DATE: `s S SIGNATUFs.:
Stipulations:
l$ 8(e.-
• (3
C?/. 63
HUUSE LUUAIIUN. PLAN
• OF BLOCK 3
CARLSON'S SUMMIT MANOR SOUTH ADDITION.
FRIDLEY,ANOKA COUNTY, MINNESOTA
FORi -
----I Y
= ARVI D E. CARLSON & SON INC.
a 3200 FRANCE AVE. S0.
3rd. STREET '�� N.E.
14 73 8 i 5 75 7s 75
as
X7:4' .. R.f' fz.a I ...w, Ij.L 40.2It - 4 t qi
ss 4980 ^ 2 fill", 2.2 JL.4 ' 40.2 i
1x.4 • iS4 0 ! •ee•
13
1 4
,y Z
lit.
I
acs 14 15 16 17 IS 19 i 20 4 i4%
a -
N -45 — 75— — — 75- — 75 y-73 _ 75 eo - �
12-- I 29.2 Z
- — — — — — — W
f,.4_� N• 1 �- i ti�,� 10 9 8��� �� 6 5 4 0l t 2 ;' N d
w
Q — !!0-�'
ei e1 •, 1 'tr •RSfVC,� D .! oa 402
40.2 4e.t
z A.
4 oY1A5r•x.Q , 14w:1 40.20 �486494
,tM
49T7n
4 �PP!!_1111Zi
1v .
29 'N 40.2 '' �
ol
CL zm
`6rt ^11 24t
, =
•
70
75
_ )f2
_
f
• ROMAN ROAD
2 hereby certify thwt the above is a survey of lots One (1) through Twenty (20). Block
CAFa:At:'5.SMy;T J, , It :O= ADDM, W. Anoka County. Minnesota. sharing the
losatlon of the houses on said lots. ,
As surrfeyed by the this 16th day of April 1955 A. D.
OGAR
CONSTRUCTION. INC.
Permit by
Legal Descriptio
Blk
Add'n
Value
TVDe Const.
WORK ORDER
HOME PHONES-:7j'?�( y
NAME- /14• Sj4'L'Q (�r�L BUS. PHONE:
JOB ADDRESS q �5-3 , C-6
BLDG CODE AREA.e(Zf
SALESMAN Ior&'L CONTRACT DATE SIZE Wit;
aAB:
LXBy HOGAR I CONTRACTO
❑ By Owner Approx.
❑ In
2 -START I�G l PINTS ONLY
S.P.L. SS z.
S.S.P.L.
R.P.L.
Alley Lo
House —'
F. Street
Other
❑ Square With A4e-A,-<_, ,
Sod Rem. By/
afA.B.U.
❑ A3 Grade P int
RQn��il
Blocks:y Owner L1By HOGAR
O Wtr.proof: ❑By Own. OBy HOG
11 Backfill: C ❑
IBv Own. ByHOGAR
❑ Maintain 8' Total Wall Height
Including Blocks OR
QMaintain 8' Wall Height on
Top of Blocks
Block Size (Top course)
❑ 8" ❑ 6" ❑ 4"
Wall Height other than 8'
❑ Frame with full wall height
sold OR
❑ Cut studs as required for
OHD clearance
!o.H. Dr Offset
JXS.D. Location
Windows
❑ Att Gar Roof Tie-in
Drawn on attached pictures
Existing garage: No ❑
❑ Detached ❑ Attached�Y'e 2C
Size of existing: x
Existing garage will be:
O Left as is
Converted to L.S. - By owner
Removed By: Owner ❑
HOGAR ?!-
Junk Must Be Removed By Owner
OSpeci�okdist.
HOGARor
wn, etc.
❑ owrage to
house and allprop. lines
Stakes visible - ❑ Yes N No
Survey available -kYes ❑ No
❑ Special instructions from
owner:
FOR OFFICE USE ONLY
JOB #
,
j
1
For
lilt
d
r
Ay
1111
n
XCCESS
. _.
'
�.
i
O Good
Fairyyy--
I
2
❑Poor J
;
x -
i
PURCHASER'S
INITIALS:
DI ON
CITY OF FRIDLEY
Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
QFR TnFWrP TA T.
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
* Air Conditioning (all sizes)
All Others/Repairs and Alterations
18 of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
RATE TOTAL
$ 20.00 $ 2a'
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 10.00 $
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp.
Date
Approval for Permit d
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
.1
$ .50
Job Address 7 -f ✓ 444A.) 440 Al -e
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Tel. #571-3450
The undersigned hereby makes application
for a permit for
the work herein
specified agreeing to do all work in strict
accordance with
the City Codes
and rulings of the Department of Buildings,
and hereby declares that all the
facts and representations stated in this application true and correct.
Fridley, Minn.
`/are
�' /
, 19
OWNER //! -5;&/ 4P 1/4) d�
Tj
KIND OF BUILDING /Q./Q`4J!5
USED AS Aw F. L L
-
J Q
�/ 71-
TO BE COMPLETED ABOUT / t�F/
ESTIMATED COSTyOD
PERMIT NO.
OLD - NEW BUILDING PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
HEATING or //PJJOWER PLANTS, Steam, Hoot Water, Warm Air- No.
/�
Trade Name (.�Von /�OQJ�4Size No. C5 �!'/'
Capacity Sq. Ft. EDR BTU�/H^P
Total Connected Load , Kind of Fuel 4A J'--
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR •'BTU HP
Company ;<W,AP �� dT/Cf,
Signed Byoe� �.
Tel. No. -4'7Z--��
Fill out back side for stack verification on replacement furnaces
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1.
Has
been carefully examined
Yes (�)
Z.
Is
free from rust or deterioration
Yes ( )
3.
Has
no foreign objects lodged within
Yes ( )
4.
Is
securely supported
Yes V-)
5. Meets all current Code requirements for size and
total BTU connected Yes ( )
6. Has Total heating BTU's of TG(
All other BTU's
TOTAL
No ( )
No (�c)
No ()t )
No ( )
No ()
Remarks (f k Wq-"5 &J
CG ,SSS VF -W'7- Z .�%PG.r105 /lZG , f
` 7—X 4NS / i'6— ,
Company �.�iAI�P //7-��
Signed Byoef X)•
Da to /`I/z!5--- 966
CITY OF FRIDLEY INSPECTION DIViSION
Effective On January 1, 1998
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER
PLANTS AND
HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR
CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS "7' q -S' S RDak
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner -
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00
$
representations stated in this application are true and correct.
(Side Vent - Fill Out Back)
1998
Gas Piping (Needed with new furnace) $10.00
$
IC
OWNERS�,q L) 0
Gas Range $10.00
$
BUILDING USED AS
Gas Dryer $10.00
$
ESTIMATED COST f PERMIT NO.
_-U&Conditioning - All Sizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name to Size No.
Commercial/Industrial
BTU HP EDR
1.25% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
.50
Burner Trade Name Size No.
TOTAL FEE
S
BTU P EDR
Sharp
Heating and Air Conditioning
,
HEATING PAN 4854 Central Ave. NE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATIONColumbia
Heights, MN 55421
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
Signed �e�No?'0459
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
Approved Rough -In Date Final Dates Z
*Air Conditioners can not be placed in a side yard without
FILL OUT BACK SIDE FOR ST CK VERIFICATION ON
written permission from adjoining property owner.
REPLACEMENT FURNACE
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater, Yes ( ) No ( )
8. Has combustion air been provided for water heater Yes ( ) No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CMMNEY AND STACK VERIFICATION
The
undersigned` hereby verifies that the existing chimney
or stack:
1.
Has been carefully examined
Yes ()
No ( )
2.
Is free from rust or deterioration
Yes ()
No ( )
3.
Has no foreign objects lodged within
Yes O
No ( )
4.
Is securely supported
Yes ()
No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater, Yes ( ) No ( )
8. Has combustion air been provided for water heater Yes ( ) No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
From: City of Fridley To: 65164673M Page: 215 Date: 3!2612MM 10:43:15 AM -4r-4,44,4
` Building MECHANICAL Pennit No::"aQ
Inspections IESIDE TIAL AppLICATION Received By -
763 -572-3604 AUG
CITY FRIDAY late
763-502-4977 F
Er�'ECTIVE�-t9.09
DATE r� o YOUR E-MAIL l?i7RL'SS
i
SITE ADDRESS
THIS APPLICANT IS: DOWNER OCONTRACTOR
PROPERTY
NAME: -»
OWNERS
ADDRESS: Sri _ ' CITY STATi
TENANT
PHONE:
CONTRACTOR
COMPANY NAME:
SUBMIT A COPY OF
W SNELLING COMPANY, W.
CONTACT PERSEIN_
STATE LICENSE ff jIATE
YOUR STATE
LICENSE WITH
ADDRMMIM 331U,4 CITY STATE ZIP
APPLICATION
PHONE
PERMIT TYPE
*NGLE FAMILY O TWO FAMILY EI TOWNHOUSE
TYPE OF WORK:
O NEW REPLACEMENT Q ALTERATIOWREMODEL
DETAILED DESCRIPTION OF—WORK 4—
FEES ARE BASED ON 510.00 PER FIICrURF, LX T W ERL NOTKD. FIXTUU& LXD1C t L TO 'A�yVU [BLIi.OF EACH 1� tiOV
Egnipmnt Installed NTNG: �� A4ODEE: e SIMSTU � �
MNG: > MODEL: Slzwwu-cx�wo
MFG- MODEL: SIZE/BTU
A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGEK1VtN $4000
TO AIR EXCHANGEER $115 FIREPLACE(WOOD)$35,00 GAS GRILL.$10.00
_AIR `Nl<Lr+
BOILER $35.00kURNACE $35.00 GAS (SNIT HTR $ E0.00
CHIMNEY LINER $10.00 _GAS DRYER $ MAO POOL HEATER $35.00
—POOL
_DUCT• WORK $10.00 GAS PIPING $10.00
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...>..>....>r. _...... 3...... ..>.. r..:.. >..«r...., }:..r.......a _r__...r.-.•>......_>.... >_....-r...._:._.. ra..:...._ a-:xaa}}n•.:, . - :._. }as�-
...
_....
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................................ .... ... .... ...... _-'__'-_•-•_•-.____ _._ :z•:•z..aw>-.;w_. .. .S:ir:rr??:t:t?r.? _?i:i.}Y:rxii?.y :q:.:a.
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THIS IS AN APPLICATION FORA PERMIT -NOT VALID UNnL PROCESSED
1 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 ordinan of the City of Fridley and with the Minnesota Commetion Codes, that I understand this is
not a permit but only an app tion for a g t and work ' not to _start without a permit, that the work will be in accordance with the
approved plan in the ease of P1 w fires approval of p
,/ , ,
SIGNATURE OF y i►l�
APPLICANT DATE.
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P.�•.-:--'t�'�.=<�SP.���:'.�=�' .:: •.�_�.=.>:�3# < =:= �#t �_ tom€ : _ �t�t��<��:i�f=�>=
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Gity of Fridley
Building Inspections Department
6431 University Avenue NB, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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