PRE 2010 DOCS53-84-s-91.5.51
City of Fridley
AppRwdion for Pkmbbg ted G= R"kq Penn*
Dept. of 81 -Ace Phone 960-34.80
DESCRIPTION OF WORE
Number. Kind and Location of Fixtures Lm:t� 5871 West Moore Dake Drive
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL.
Number Fixtures ................ x $2.00 $
Future Fixture Opening ............ x $1.50 $
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater (Up to 99,000 BTU) .... x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Electric Wager Heater .............. a $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
ist 3 Fixtures ............... x $2.00 $
Additional Fixtures .................. x $ .75 $
Gas Range to 199,000 BTU.. . 1 x $5.00 $ 5.00
REPAIRS A ALTERATIONS—Refer to Code
City of Fridley:
The .undersigned hereby makes application for a permit for the work herei
specified, agreeing to do 411 work in strict accordance with the City Ordinance
and ruling of the Department of BuildizW, and hereby declares that alk the fact
and representations stated in this application are true and correct.
Fridley, Minn- 7-31"-72 19—
Owner Bernard W. Wedgewood -
Kind of Building Frame
Used as Res.
To be completed about 8-7-72
Estimated Cost, $ 10.00
'OPPLNew. Building Permit No. - Permit No. �,--�
Signe
By �BGAi�3�cr� --
Business Phone No
ROUGH
Description .............................................$ ton -V hfta $ s50
TOTAL FEE $ 5.00
(SURCHARGE _.5G)
` `
r 122 F
C
< `g
6 1
�j uS� �g1 7 g' e e
< (7 i � � (•I p -1 1A
WATER MTV.
GAS
ELEC.
Base
1st
1
2nd
3rd
44th
° Future Connec*m Openings
* New Flxtnre, Old Openings
_...
Connected with Sawa
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL.
Number Fixtures ................ x $2.00 $
Future Fixture Opening ............ x $1.50 $
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater (Up to 99,000 BTU) .... x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Electric Wager Heater .............. a $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
ist 3 Fixtures ............... x $2.00 $
Additional Fixtures .................. x $ .75 $
Gas Range to 199,000 BTU.. . 1 x $5.00 $ 5.00
REPAIRS A ALTERATIONS—Refer to Code
City of Fridley:
The .undersigned hereby makes application for a permit for the work herei
specified, agreeing to do 411 work in strict accordance with the City Ordinance
and ruling of the Department of BuildizW, and hereby declares that alk the fact
and representations stated in this application are true and correct.
Fridley, Minn- 7-31"-72 19—
Owner Bernard W. Wedgewood -
Kind of Building Frame
Used as Res.
To be completed about 8-7-72
Estimated Cost, $ 10.00
'OPPLNew. Building Permit No. - Permit No. �,--�
Signe
By �BGAi�3�cr� --
Business Phone No
ROUGH
Description .............................................$ ton -V hfta $ s50
TOTAL FEE $ 5.00
(SURCHARGE _.5G)
k /Z
SUBJECT
PERMIT N.O.-- —'
City of Fridley
12339
AT THE TOP OF THE TWINS
BUILDING P E R M I T
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
1 PROTECTIVE INSPECTION SEC.
� � ^
CLj
1 . �
' i. .--n CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�`---� 612-560-3450
910-F15
10/3/73
JOB ADDRESS 5871 West Moore Lake Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
4
1
SHEET
1 Donna 'S Lakeview
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Bernard Wedgewood 5871 West Moore Lake Drive N.E.
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 EX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBEWORK Construct attached garage (16' x 25')
9 CHANGE OF USE FROM TO
STIPULATIONS Provide a hard surface driveway. Provide fireproofing on the
JAA7I south side of the garage.
- pERMITS REQUIRE[) FOR WIRING,
sEP ERATE
HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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
014 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,812
.91
DOES NOT PRESUME.TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW PTEGULATING CON-
8.00
STRUCT) R THE PERFORMANCE OF STRUCTI N.
PLAN CHECK FEE
TOTALFEE
S NATUREOFCONTRAC ORORAUTHORIZ AGENT (DAT
s
HE ROPER.LY VALIDA D THIS IS YOUR RERMIT .f
BLDG INSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
APPLICATION FOR RLSIDENTIAL, ALTERATION,
OR AiMITION BUILDING PERMIT
C ITY OF 1.1-)1 DLLY, M J NNESOTA Cl
OWNER I S NAME : --e 1 C-) /�t_ C "� BU DER : Y h
ADDRESS: ADDRESS:
NO: 7 STREET:ZL—.,p
LOT: BLOCK: � ADDITION: ifAL61elvS 0
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD;
Applicant attach to this form Two Certificates of Survey of Lot and proposed
buildixig location drawn on these Certificates, _
DESCRIPTION OF BUILDING
To Be Used As:
I� C1 ca Front • Depth: Height
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type: of Construction:
To Be Completed:
Estimated Cost:_y
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that -ill the facts and representations stated in this application
are true and c orrt•c t .
DATE: S [(;NATURE:
(See Reverse Side For Additional Information.)
Land Planning SmAr Lla� 6875 Highway No. 65 N. E.
Land Surveying �/�► • •/+ Minneapolis,
soils Testing �ZQZ�lPe�;G�i fJ,GC• Minn. SS432
Civil Engineering (vI Telephone 784-6066
Municipal Engineering Engineers & Surveyors Area Code 612
Mortgage Loan Survey for r, VedkNood
j
\ ��S
scalep�
x,-
AUGUST 13
tis► ��
LOT 4, &LOCA I
V, ; CONNAY'S L4EVIEW
ANO AMMON
7F
This is a true and correct representation of a survey of the boundaries of the land above described and of the
location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. This survey is
made only in connection with a mortgage loan now being placed on the property and no liability is assumed
except to the holder- of such mortgage or any other interest acquired by the reason of such mortgage. It is
understood and agreed Qo monuments hpve been placed for the purpose of establishing lot lines or boundary
corners. Dated this 10 day ofAu�A. D. 19_ .•
,'_342 • SUBURBAN ENGINEERING, INC. -
7T * Engineers Suryeyo�s
byes
s
174
560-3450
ciry. O
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE January 7, 1975 FRIDLEY, MINNESOTA. 55432
Mr, Bernard Wedgewood
5871 West Moore Lake Drive N.E.
Fridley, Minnesota 55432
Re: Building Permit #12,339
Dear Mr. Wedgewood:
The above noted building permit was issued to you on October 3, 1973
to construct an attached garage.
Our department conducted an inspection on January 7, 1975 to check the
progress of this construction and noted no construction has commenced.
We therefore have to void this permit and if in the future you wish
to construct a garage, a new building permit will have to be applied for.
If you have any questions on this matter, please contact this office
by calling 560-3450, ext. 41.
Sincerely,
CLARENCE J. BELISLE
Building Inspector
CJB/mh
A
SUBJECT
PE
City of Fridley
628 1
AT THE TOP OF THE TWINS
BUILDING PERMIT
ip
• COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
1 ; �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE
OF
APPROVED BY
612-571-3450
910-F15
17/10/81
JOB ADDRESS Bernard Wedgewood 5871 West Moore Lake Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
1
1 Donnay's Lakeview Manor Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Bernard Wedgewood same
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
storage shed
7 CLASS OF WORK
❑)( NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
construct 10'x14' storage shed
9 CHANGE OF USE FROM TO
STIPULATIONS
Must be tied down or attached to a cement slab
SEPERATE PERMITS REQUIRED FOR WINC.3%
HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
wood
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
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
500.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.50
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
TOTAL FEE
8.00
SIG RE OF CONTRACTOR OR UT ORIZ GENT (DATE)
N PROP RLY ATE T SIS Y PE MIT
P
AA
BLDG INSP DATE
-SIGNATURE OF OF OWNER OF NER BU D .1 (DATE)
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PER4ITS
Vl.csr, Alterations, Additions„ or Repairs)
ADDRESS: (5 -le 2 // d-2 E
DUILDI_R:
ADDRESS:
TEL (-10:
Construction Location
STRIMT NO: •.c} STREET: LX)22Z® A
LOT: BLOCK: Z ADDITIO11.
Corner Lot: Inside Lot: Setback:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: l Depth: % yC Height:
Square.Feet: Cubic Feet:
Front: Depth: Height:
Square- Feet: Cubic Feet:
Type of Construction: Estimated Cost: $ �j~®
Zb Be Oompleted: t
' Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the �:nrk' herein specified,
agreeing to do,all work in strict accordance with the.City of rridley 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. ^ r,
DATE: %® - ez SIGNATUM:
Stipulations:
-g-,e/ �X r
01
SUBJECT
PCE.
City of Fridley
5rAT
THE TOP OF THE TWINS
gUILDING PERMIT
R
• _ COMMUNITY DEVELOPMENT DIV.
t �(
r PROTECTIVE INSPECTION SEC.
t �
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
ti' ---ilk, 612-571-3450
910-F15
9/18/85
JOB ADDRESS 5871 West Moore Lake Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
4
]
Donnay's Lakeview
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
B. Wedgewood 5871 West Moore Lake Drive N.E.
571-6373.
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
Construct a 24' x 161 Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway, Variance granted. 10/9/84. South wall
to be 1 hour fire rated with_ no openings.
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
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
4 680.96
$2,34
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-
$50,50
STRUCTION OR THE PERFORM NCE CONS TRU TION.
PLAN CHECK FEE
TOTALFEE
®"s/,P'ys-
$52,84
SIGNATURE OFCONTRACTOR OR AUT RIZED AGENT IDATEI
WHEN PROPERLY
DATED THIS IS YOUR PERMIT
+
L DG INSP
�ttE
SIGNATURE OF OWNER OF OWNER BUILDERI DATE)BL
01
NEW [ ]
ADDN. [
ALTER. [ ]
Construction Address:
Legal Description:_.
Owner Name & Address:
00,
Contractor:
Address:
LIVING AREA:
r.ARAnV ARRA
DECK AREA:
OTHER:
City of Fridley
�R-1 AND R-2
Building Permit Application
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
Length Width Height
Length Width Hgt/Ground
Effective 4/1/84
Tel. # 627 / - 6
Tel. #
Sq. Ft.
Sq. Ft.
r
Sq. Ft.
Corner Lot [ ] Inside Lot [J] Ft. Yd. Setback Side Yard Setback
Type of Construction: C A.) � C1 VV- Estimated Cost: -
Approx. Completion Date: /mss-
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: n cv Lx, $
See Back Page for Explanation
C ---L
DATE: ® ® �' APPLICANT: Tel. # 6`71- & 3'73
CITY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sever Main Charge
STIPULATIONS•
(J A rZ , v ,6(- 0� Q>
7SIO v -b L-") i�- Vt'. rt
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 [ ]
10 -9- F V
0
GAJ l r 't-4� U fa
C� P Ai d'
Landplanning
loi Surveying • •
soft Usflne,-
Civil EnggineerHtg OF•
teipal Etsgiaseeritng Engineers & Surveyors
Mortgage Loan Survey for Vedl
r� i
AY -
6875 Highway Wo. 65 W. E.
Minneapolis,
Minn. 53434
Telephone 784-6066
Arco Code 614
f
AUGUE 13
�� UT 4 , &OC
00NN&'5 1. EVIEIN
MANOR ADDITION
Amb n
A
This is a true and correct ropresentation ';iol survey of the boundaries of the land above described and of the
location of all buildings, if any, thereon, aaa�t visible encroachments, if any, from or on said land. This survey is
Mode ordy is connection with a mortgage lean view being placed an theproperty and no liability is assumed
except to the holder of suA roortgoge or any other interest acquired by the reason of such mortgage. it is
wtderatood and agreed go hQQ ve be" plated for the purpose of establishing for lines or boundary
corners. Doted Mise vfA. B. 19�
L342 .�:` SU6URBAN ENGINEERING, INC.
X77 — - . r „ n fsgin ds Shur ye
4
111
SuBjECT
PE
City of Fridley
33889
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
___
r -__ PROTECTIVE INSPECTION SEC.
1 . .
NUMBER
REV
DATE
PAGE OF
APPROVED BY
� --i CITY HALL FRIDLEY 55432
�-�� ,'' 763-571-3450
910-F15
9/16/03
10B ADDRESS 5871 West Moore Lake Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
1
Donnay's Lakeview
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Brad Wedgewood 5871 West Moore Lake Drive NE
763-537-7766
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 O ADDITION O ALTERATION REPAIR
O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (22 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building
Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED 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
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$2 547
$1.27
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
TOTAL FEE
$87.07
Si URE CON 'RACrDRO MOR ED AG t tOATEi
�-"
HEN PROPERLY
INS
VALIDATED
THIS IS Y +R P MIT
1� 00
r)AtE
SGNAIURE O�OW WNE L 1DATE�
111
NEW [ ] CITY OF FRIDLEY Effective 1/1/2003
ADDN [ j 6431 University Ave NE, Fridley, MN 55432 (763) 5724604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax
BUILDING PERMIT APPLICATION.
Construction Address:
Legal Description:
Owner Name & Address: �°� u Tel.
Contractor. 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
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Le th Width Hgt/Ground Sq. Ft. _
OTHER:
Construction Type: Estimated Cost: $� ,
Driveway Curb Cut Width Needed: Ft. + 6 Ft = t x $ $
DATE: ' APPLICANT: Tel. S_ZL
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
-)r—
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$ /, �'� $.50/$1,000 Valuation
$ $1275 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ C9 STIPUI ATIONS-