PRE 2010 DOCSYZ
Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
Partial Rate Schedule
CI
GRAVITY WARM AIR: RATE TOTAL
Location....�.®.....s..l..'.?.......w....�"1....e...�......---.- ..............................
FurnaceShell & Duct Work ................................... _.......... _........... 8.00 $ .................................
Replacement of Furnace ...... 5,00 $. _ �-, City of Columbia Heights:
5.00 The undersigned hereby makes application for a permit for the work herein
Repairs & Alterations—up to $500.00 ............ ................ $...........--------•----..•••• specified, agreeing to do all work in strict accordance with the City Ordinances
Repairs & Alterations each add. $500.00 .................... 2.50 $ ...... .......................... and ruling of the Department of Buildings, and hereby declares that all the
facts and representations s ted in this application are true and correct.
MECH. WARM AIR 67
Furnace Shell &,bct Work to 120,000 BTU .................. 8.00 $............ _....... ........ ts, Minn .......................... ...........�................ 19,.K...7..
eachadd. 60,000 BTU ................................................... 2.00 $..... _.._.....................
Owner ............... .:............ _............................................... _..........................
_ ..............................
.
Replacement of. 'uinace........................................................ _........... 5.00 $_. ,..-c.._ �.0
Repairs & Altezhtiiins-up to $500.00 6.00 $ Kind of Building .............................................................................................................
....._.........._......._. ....._......_.....__._..... f
Repairs & Alteratos each add. $600.00 .............................. 2.50 $........... _._..._..........
.: Used as ...................._........ _.............................. ...
STEAM or HOT WATER 'SYSTEM
To be compeletd about
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $._ ........ ................ _....
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 8.00 $___. _...... ........... Estimated Cost, $ ..... _....................... .......................................................................................................................
Each add. 200 sq. ft. EDR Steam ................ .......................... _.. 2.00 $..... _......................
1 New. Building Permit No ............................... ........... Permit No.. _ .J.f .�....._...........
Each add. 320 sq. ft. EDR Hot Water ..... . ................ _........... 2.00 $_....... _...... _...........
OIL BURNER—to 3 gal. per hour ................ _............ _......... _... 5.00 $ ................................. DESCRIPTION OF WORK
over 3 gal. per hour—See Fee Schedule ••-•••....... .. •-••••• HEATING or POWEPLANTS—Steam, Hot Water, Warm Air—No.........................
GAS BURNER (up to 400,000 BTU) ............ ............................. 5.00 $..... ._..._... _._...........
Trade Name.... ........ .. ..... :..._............................................ Size No.........._..........
GAS FITTING FEES: NO RATE TOTAL ._
1st 3 Fixtures .................... x 1.50 __. _..... Capacity ..... "y_.'W.��......... H. P.
$ $ - p Y ....................................... Sq. Ft.EDR............................... BTU
Additional Fixtures _._._...... .. x .50 $ ............. ..........._.....
Total Connected Load....................................................:............ Kind of Fuel .117
Gas .................
Gas Range to 200,000 BTU ........... _.... _..... x 2.00 $............ __. ............... (/
VENTILATING SYSTEMS BURNER—Trade Name..................................................................... Size No ............. _..................................
Duct work etc. not to exceed 2,000 cfm ........................... 6.00 $ Capacity ....................................... Sq. Ft. E D R .................. _......... ... ..BTU................._. ..... H. P.
Each additional 1,000 cfm................. __.............. _....... _..... 2.50 $..... ... .......... ...........
AIR CONDITIONING $---- _.._------- ._......... Signed......`.':
.-U6UWAM-CflNOM- 0NING-ft .................
FAN HEATING SYSTEM See Fee Sche ule $............ _... _.............
8414
ALTERATIONS &REPAIRS By....................................................._.........._. .
$....._.............._......... 11INNEAPOUS, MINNESOTA 5543.
00
Business Phone
TOTAL FEE $ fid.. %_............._.....
1�To....�.-��/(��..............
(remarks—over)
SUBJECT
PE NO.
City of Fridley
® 12558
AT THE TOP OF THE TWINS
BUILDING PERMIT
R 0.
• COMMUNITY DEVELOPMENT DIV.
�y--------
PROTECTIVE INSPECTION SEC.
`/L/��
`l
7
1 �
� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-560-3450
910-F15
15/28/74
JOB ADDRESS
4548 2nd Street N.E.
1 LEGAL
LOT NO.
BLOCK ITRACT
OR ADDITION SEE ATTACHED
DESCR.
3
13
Plymouth Addn. SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Roger Frakie 4548 2nd Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Ernie Mithum 605 59th Avenue North
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
garage
7 CLASS OF WORK
lj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
18 x 22 garage
9 CHANGE OF USE FROM TO
STIPULATIONS
1.Provide automatic garage door opener.
2.Provide a hard surface driveway.
Variance granted by City Council May 20, 1974
SEPERATE PERMITS REQUIRE; FOR WIRING,
HEATING, PLUMBING ANP SIGNS,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
wood f ram
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
378
31780
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.
2 098 80
1.04
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-
7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
?
$8.54
SIGNATURE OF CONTR TOR OR AUTHORIZED AGENT (DATE)
.(J PROPERLYVA D TED THI IS YOUR R MIT
t
�,•>�
BLDG. INSP DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY -OF FRIDLEY, MINNESOTA
OWNER'S NAME: BUILDER:
ADDRESS: ADDRESS:_ a
NO:. STREET:
LOT:.—BLOCK: 13- ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front:_ f Depth: o{y�� Height:
Square Feet:Cubic Feet:
Front: Depth: Height:
Square Feet;
Cubic Feet:
Type of Construction: Estimated Cost:
To Be Completed: 7 `f
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.
DATE: SIGNATURE:
(See Reverse Side For Additional Information.)
j
SUBJECT
City ®f Fridley
2 2 2 9 9
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
-RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
U'
r ; PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
JOB ADDRESS 4548 2 Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
13
Plymouth Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Cynthia Gauthier 4548 2 Street NE 574-7288
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
R &-M Associates 3482 Auger Ave, White Sear Lake MN 55110 770-9322 4391
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 O ADDITION j7 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Windows & Door replacement
9 CHANGE OF USE FROM TO
STIPULATIONS
Egress wi-ndows must meet state building code.
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
STALLS GARAGES
VALUATIONSURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$7,295
$3,65
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-
$99,00
Fire SC $7,.30
,STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
License SC $5,00
$114,95
SIG TU OF CONTRACTOR OR AUTHORIZED AGENT IDATEi
WHEN P ERL VALIDATED THIS IS YOUR PERMIT
-9-` &/
OG INS DATE
SIGNATURE OF OWNERIIF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/1/94
ADDN [ ] CITY OF FRIDLEY _
ALTER [ ] • SINGLE FAMILY AND DUPLEX . R-1. AND R-2
Building Permit Application
Construction Address: 2 Ard '7 —r
Legal Description:
Owner Name & Address: ;r _��,��, �r Tel. # 37 G/ —�,e7 7 T
Contractor: �- �5®< MN LICENSE #®� tj'3
Address: 3 5/ 'y' 13, 0— �c/%cp Tel. # "77® - l' 322—
Attach
22—
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:
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction:%� �l y as,� d n �, 5 -j- dor o $ Estimated Cost: $ 7 9
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ftp b Ft = Ft x $ _ $
DATE:_ APPLICANT: Tel. #77e: %/jZ
.14
xr-IffY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$9, on
$��
$ 3 -
111-1.2L L
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$800 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 [ ]
$
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
i 572-3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES:
:Urinal i
S o e
h w r
':
as
Tra
.:........:FI00r
Drain
�'I�as�r��
e
Washer
"t`<''
�#�`�'' ........
�iwi��i�i>
Ran e :
4.
Water He' ate r
Stories
Gas lec
Ga E
ase
B ent m
$ 7.00
Water Treating Appliance
$10.00
Water Heater —Electric
$ 7.00
Water Heater — Gas
$10.00
$10 00
Floor r 1
Floor 2
00
FI r 3
In—in
Floor 4
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4:.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater —Electric
$ 7.00
Water Heater — Gas
$10.00
$10 00
JOB ADDRESS
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 Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner 4 SCS d CI 't
Building Used As Qe_g5tio
Gas Range
Gas Dryer $10.00 Estimated Cost oo PERMIT NO.
Back Flow Preventer Required ( )Yes () No
Type 45.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
State Surcharge
PLUMBING COMPANY�`71
. c
XW,
SIGNED BY ���, j- TEL NO. 1117
Approved By. ro Rough—In Date Final ate
50 J
TOTAL FEE $ SKsc PLUS THE $.50 STATE SURCHARGE
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
BUILDING
PERMIT
PERMIT NO
4 3 8 5
Ir
COMMUNITY DEVELOPMENT DIV
L PROTECTIVE INSPECTION SEC.
r
CITY HALL FRIDLEY 55432
' 612-571-3450
RECEIPT NO..
NUMBER
910-F15
REV
DATEP
7/23/96
AGE OF
APPROVED By
JOB ADDRESS 4548 2 Street NE
1 LEGAL
DESCR.
LOT NO.
3
BLOCK
13
TRACT OR ADDITION
Plymouth Addition
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
Cynthia Gauthier 4548 2 Street NE
ZIP PHONE
574-7288
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
R & M Associates 3482 Auger Ave, White Bear Lake MN 55110 770-9322 4391
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 p ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Garage (6 Sq) 2nd Layer; Reside House & Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
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
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
1 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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
$5,700
SURTAX
$2.85
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONSAF ANY OTHER STATE OR LOCAL LAW REGULATING CON -
TR CTION THE PERFORMANCE OF CONSTRUCTION
$112.25
Fire SC $5.70
PLAN CHECK FEE
TOTALFEE
License SC
$5.00
$125.80
SGNAT E ONTFACTOR ORAUTHORIZED AGENT (DATEI
WHEN PROPERLY
BLDC/I S
LI DATED THIS IS YOUR PERMIT
L4l� 3
riATE
S)G ATURE OF OWNEROF OWNER BUILDER) IDATEI
NEW [ ] Effective 8/1/95
ADDN [) CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress:
Legal Description:
Owner Name Address: `� i°- tF Tel. # 5���% �� �� -
Contractor: t M ti C _ MN LICENSE #1-13!71
Address:."% .1 , ,44,r- .3"-r®®n Tel. # `7 Zr, —3 -3
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:` Width /Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: r .-, Estimated Cost $�
21
Approx. Completion Date: n�G� ����,, y� �, el r 4i c�� cis -t Com. re It -
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. 6 Ft = Ft x $ _ $
DATE: `�";%. APPLICANT: Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
l i --2
Fee Schedule on Reverse Side
Fire Surcharge
$
`7
.001 of Permit Valuation (1/10th%)
State Surcharge
$
>S`�
$.501$1,000 Valuation
SAC Charge
$
$850 per SAC Unit
i License Surcharge
$
CIO
$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
$
Os-' 5�o
STIPULATIONS:
V�� 711
Building BUILDING
Inspections RESIDENTIAL APPLICATION Received By:4
763-572-3604 CITY OF FRIDLEY Date Rec'd:
DATEd ' / • U A YOUR E -MA ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER �-CONTRACTOR
PROPERTY OWNER/
NAME:
Gvt �f.^GC
ADDRESS:
r
/� !
CITYSTATE�iZIP
TENANT
PHONE: J3
5 7,�- — S
CONTRACTOR
NAME: -'
- it 1� G
STATE LICENSyI % U EXP DATE
ADDS ' 3 Y LIZ�— my
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
p – 6 J. d FAX
GkCNGtE FAMILY/NEW CONSTRUCTION
_ 6
SIZE
PROPERTY TYPE
-
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PEI'iPE \
❑ ADDITION
0 GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH ROOF
❑ DRAIN TILE
j
❑ DECK
❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ''
—
❑ NEW ❑ ADDITION
b'MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
P�� �('i��
�' e -
SIZE OF IMPROVEMENT
LENGTH
WIDTH HEIGHT Sq. Ft.
ROOFING
NUMBER OF SQUARES LI
HHOUSE ONLY
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No
LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDINGTHE OUST UY LA 3UX A UJ YIAI EKiaL3:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee $ i j J,S See Back Page for Fee Schedule
Plan Review $ — 65% of Building Permit Fee
Fire Surcharge $ P < U .001 times the total job valuation
Surcharge $ , �-(7 .0005 x Permit Valuation Minimum $.50
License Surcharge $ '5; 0-0 $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $20 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ Az7� le", Make checks payable to: City of Fridley Attach Stipulations
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 ordm* ces and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicati 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 of all work c requires review and approval of plans. �9
SIGNATURE OF APPLICANT PRINTNAME� 14�JI f i S DATE��� ��U _