PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT N® 3947
Date: ... ....�...... .\ .....
Owner ....................................... Builder .. ..... ......
Address ...................................... Address .............................................
AT19N OF BUILDING
No.. ! ./. Street . �:C ...... �! ... Part of Lot ...............................
Lot ............ Block .................. Addition or Sub -Division ......................................
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION OF BUILDING
To be Used as:
. ... .. ......
Front 010.'1-0 Depth :� Height 19 .n -P Sq. Ft. !
�f
CU., !. pp o
....................
Type of Construction
Front ........ Depth ........ Height
................... Est. Cost. -1-392—P.
... Sq. Ft. ........
7 . To be Completed ...................
Cu. Ft. ........
In consideration of the issuance to me of a permit to construct the ding desribed above, -Agree to do
the proposed work in accordance with the description above set fortboA
and incomiplian wi all o ion
ordinances of the city of Fridley.
ly ....... ......... .. ..
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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. >' r J
}wilding 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.
I
City of Fridley
Application for Plumbing and G"n Fitting Permit 53-84-879.01
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK Location53�, St.
Number, Kind and Location of Fixtures
+�
;
?
��
x $1.50
uZi
;�
o�
$
Z<
�o
ua1
Um
p+�ju��
G3
�°d
w
��n
Z
�O
O
R
N
WATER HTR .
GAS
ELEG
Base
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ...... ...................
x $2.00
$
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
Replace
(1) gas range $3®00
REPAIRS & ALTERATIONS—Refer to Code
lot
2nd
3rd
4th
_
° Future Connection Openings
New Fixture, Old Openings
Connected with
Sewer El
Cesspool El
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 Water Heater
s $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ...... ...................
x $2.00
$
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
Replace
(1) gas range $3®00
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $ 3 ° 00
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
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 fact
and representations stated in this application are true and correct.
Fridley, Minn Jam'- 10,v 1970 19_
Owner W. Nemriann
Kind of Building frame
Used as residence
To be completed about Jill y l Kl 9711
Estimated Cost, $ 10,00
Old- New. Building Permit No v Permit No.
on nnapan
A
By
Business Pho o
ROUGH
FINAL -1*"'15 _ 71
.
53-84-s-915.-51
City of Fridley
AT THE TOP 00 THE TWIN$
6
rL'------COMMUNITY DEVELOPMENT DIV.
1{ PROTECTIVE INSAECTWN SEPT.
CM WALL i1110L4Y %$Olt
D.....�.� `.J 84-600-3"0
PLUMBING, PERMIT APPLICATI01j
Job Address
"LJ- v 1 41 1.-)l 1.3 1 1
1 1 Isvv
4543
NE 2 St.
Wer
Address
Phone
Wallace G.
Neuman Same
Contractor
Pone
Minnegasco 733 Marquette
,s Mpls
Kind of Building
Use
Frame
Res.
Completion Date
Estimated Cost
12/26/73
10.00
f
Plumbing Fixture Rates: NO.
RATE TOTAL
r
I;
I
Number Fixtures x$2.00
Future Fixtures x
$1.50
aflsYfl
i
New Fixture -Old Open. x
$1.50
'
I
Catch Basin x
$3.25
OYfl
I
�
I
I
Water Heater -99,000 BTU x
$3.00
•s,wl
I
I
�
_
II
Ground Run Old Bldg. x
$3.25
saa,
•ANN IYal
I
I
I
�!
,
!
Elec. Water Heater x2.00
$
sweve
'
f Gas Fitting Fees:
;O o
flNtra°
I
to
t
1
O •�
1st 3 Fixtures 1 x
$2.00 2.00
!o
I saaMoasl
I
I
Additional Fixtures x
$ .75
n
Install (1) Gas Range
3.00
Gas Range -199,000 BTU x
$5.00
A -
SAYalI
HsrM
I
I
�
Repairs & Alterations
I
I�
See
SMN-.1
Ll
I
Description: Code
1
I I
State Surcharge t svic��
�,p.50
9
I
6
5.50
a'
I
I I
TOTAL FA"o$
e@uv
I
!The undersigned hereby makes application
for a permit
e,rwlanl
I
I
I I
for the work herein specified, agreeing
to do all work
•a,�M
in strict accordance with the City Ordinances and ruling
I
of the Department of Buildings, and hereby declare that
aW the facts and representations stated
in this
.a
application are true and correct.
e. :✓ate..
C;
12/21/73
" Signator lllqi` CGAs -_a
Date
s
VA
Q
SUBJECT
PERMIT NO.
City ®f FridleyIr
®$
AT THE TOP OF THE TWINS
P,
BUIL ®I N G PERMIT
ECEIP
• _ _ COMMUNITY DEVELOPMENT DIV.
916
PROTECTIVE INSPECTION SEC.
1 i � CITY HALL FRIDLEY 55432
�•�
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L'--' 612-560-3450
910-F15
11/21/77
JOB ADDRESS 4543 - 2nd Street N.E.
1 LEGAL
LOT NO.BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
2 $
2
Rearrangement of P1ymout$ .Addn. Blocks SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Wallace G. Newman 4543 - 2nd Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same 560-6507
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 CA� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 22' x 12' Deck onto Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
SEF'ERAT'E PERMITS REQUIRED FOR WIRIN.GA WmINING
HEATING, PLUMBING AND SIGNS, Before digging call local Witte
TELEPHONE. ELECTRIC - GAS EtC
REQUIRED BY LA
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
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
ING I
AND ORDINANCES MPLIED
TYPE OF WORK WILL BE OPERMIT
$1,500
$
WITH WHETHER SPECIFIED
E EDHEREIN OR NOT. THE GRANTING OF AS
.75
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-
$9.00
STRUCTION OR THE PERFRMANCE OF CONSTRUCTION.
®
PLAN CHECK FEE
TOTAL FEE
6 1
$9.75
. SIGNAT REOF �RACTOR OR AUTHORIZED AGENT (DATE)
d, EN PROPERLY VALID TED THIS IS YOUR ERMIT'
BLDG. )NSP - D E
SIGNATURE OF OWNER (IF OWNER BUILDER) f )ATE)
"jam'.--';.;�
44 ✓ j �\ j" j j A i r•l -77
6
2X 6�-
i..L PmST�
3=b
ra- volt.
2 x 6 Decxrr &
SeC P(-.4,-.- ABo vC
FO 2 PR 7-ri :: R Al
2� to Rim BEAN?
2++o STD, PIPS"
I
1� Y. (,S
2 y l0 /< t!, ,(®{ r''
I it I II 11--_x.11 - Tl -
/0 -
qf
2..Y. 3 ois s
PLq". igucr, Sbpr-orc +" JOIST
6
- 1
cii
4j tiX.�-� � -
1 G,J `C` at ✓s 7`a . eo A
//�a arc. c�-Ye/• 1 csc�:.�s �-. �.. O r
zl,e-,q2,
• CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PE 4ITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER:� .r� BUILDER: UJ jq-%(...
Address : L �4 � � � � � Address:
Tel. No.
2 �0 r-
56
No.: '�"-'? - Street: i • N,, E
1-7
LOT: I BLOCK:
CORNER LOT:
INSIDE LOT: _ SETBACK: SIDEYARDS:
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: 2-3-C) Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: ® J 901r'1i 6 Esttimated Cost: $ M
To Be Completed:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
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. See reverse side for ddit#nal information.
DATE:(( /2/� SIGNATURE:
Stipulations:
IV
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
33 116
r
`
RECEIPT NO.
i COMMUNITY DEVELOPMENT DIV.
------
rr _
PROTECTIVE INSPECTION SEC.
(0-3
r I �
NUMBER
REV
GATE
PAGE OF
APPROVED BY.
IL= CITY HALL FRIDLEY 55432
___- '�
L f \ 763-571-3450
910-F 15
5/14/03
JOB ADDRESS 4543 2nd Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
12
2
Rearrangement of Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Abebe Mojo, 4543 2nd St NE, Fridley, MN 55421
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
First Class Exteriors, 10020 Olive St,Coon Rapids, MN 55433 763-754-2300
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 JD NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
= Re-side house & garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code requires that a weather-
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions to this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the
manufacturer states this in the application guidelines.
Call for inspection of wrap before covering.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING
THISPERMIT 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
$3.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$5,995.00
DOES NOT ESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SACCHARGE
PROVISIO S F ANY OTHER STATE OR L CAL LAW REGULATING CON-
Fire SC $5.99
S RUC VO R FORMANC OF STR ION
$125.25
ZTHP
��.
PLAN CHECK FEE
TOTAL FEE
$134.24
SIGNATURE OF EON71CACTOR OR AUTHORIZED AGENT 16AIE,
EN PROPERLY VALIDATED THIS IS Y URPE MIT
S,GNATURE OF OWNERIIF OWNER SUILOERI IDATEI
„ BLO INSR r1Af
IV
NEW [ ] CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: _ d —
Legal Description: ,,rr��
Owner Name & Address: Aze- F Y9��91 1 Tel. #
Contractor. S r MN LICENSE #
Address: /(Jf'c ® ��i"P� �����/ ��Si/�fo%S✓` Tel. # %K3-
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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 Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: 8'E I C Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. Ft = Ft x $ =$
Off
DATE: I,�r APPLICANT:22�'Z;7
Tel. # %�P.? �3
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
$ '57-7
7 7
$
TOTAL $ I . -
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 [ ]
FJ
Building
MECHANICAL
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
E a. ®3 007
DATE YOUR -MAI DRESS
SITE ADDRESS
THIS APPLICANT IS: 0 OWNER CONTRACTOR
PROPERTY
NAM . I
ADDRESS: ) CITY /L STA ZIP
OWNER/
TENANT
y
PHONE:
CONTRACTOR
COMPANY NAME: G.V. HEATING & AIR INC.
CONTACT PERSON: 5152 WEST BROADWAY
SUBMIT A COPY OF
CRYSTAL, MN 55429
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS: CITY 753-535--2-000 STATE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE
/TSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
0 NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK C
PER MS 16B.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 cost 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)
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
)<A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 ,_NEW GAS GRILL $10.00
_AIR
$35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
_BOILER
LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
u
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50
Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $
Number of fixtures @ $25.00 x $25.00 = $ '2
Number of fixtures @ $35.00 x $35.00 = $ s•
State Surcharge = $ ..51
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 it
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this i
not a permit but only an application for a pe it an work is not to start without a permit; that the work will be i/n c rdance with thi
approved plan in the case of all wor hic equir s view and approval of plan l
i'74 0
'
SIGNATURE OF APPLICANT PRINT NAME ` ` '` DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6.* Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
163) 572-3604 FAX: (763) 571-1287
ADDRESS 4543 2ND ST NE
PIN 263024330112
LEGAL DESC REAR BL 13,14 & 15 PLYMOUTH
LOT 12 BLOCK 2
PERMIT TYPE BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOW/DOOR REPL
PERMIT N6. --,r2004-00357
j r
DATE ISSUED: 03/18/2004
VALUATION : $ 1,000.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317
OF THE 2000 INTERNATIONAL RESIDENTIAL CODE.
CAULK AND FLASH ALL EXTERIOR OPENINGS.
REPLACE THREE WINDOWS WITHIN EXISTING OPENINGS
STATE LICENSED CONTRACTOR 1
APPLICANT
WINDOWS AMERICA OF MN INC (20248265
559 SHOREVIEW PARK R
SHOREVIEW, MN 55126-
(651)203-0149
ABEKE, MOJO
4543 2ND ST NE
FRIDLEY, MN 55421
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating cons1rruction or the performance of construction.
Bldg
BUILDING PERMIT FEE
38.75
FIRE SURCHARGE
1.00
STATE SURCHARGE, VALUE
0.50
LICENSE SURCHARGE
5.00
TOTAL
45.25
PAID WITH CHECK # 9090
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NEW { ] CITY OF FRIDLEY
ADDN { ] 6431 University Ave NE, Fridley, MN 55432
ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address:
Contractor.
Effective 1/1/2003
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
Tel. #2k ��� `� 7 �
' o
MN LICENSE # 0
` Tel. # 4r25 I ZD3 - 7 /
3 0`2�
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:
n , ,u► �; �K_ � Luc'1�estimated Cost:
Construction Type �. - � �-- - -
Driveway Curb"'Cut Width Needed: Ft. + 6 Ft = Ft x -o/ 1/7
'2� / -�f Tel. #
DATE:
J b APPLICANT:
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-5714287 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
$
Fee Schedule on Reverse Side
$
.001 of Permit Valuation (1/10th%)
$ c��
$.50/$1,000 Valuation
$
$1275 per SAC Unit
C) (
$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 [ ]
TOTAL $---------
I
f ,