PRE 2010 DOCSVillage of Fridley, Minn.
BUILDING PERMIT
N° 842
Office of INSPECTOR OF BUILDINGS
G
Owner
Architect Fridley, Minn.,
Builder
LOCATION OF BUILDING
_-..
No Street a Part of Lot
Lot Block Addition or Sub -Division'
DESCRIPTION OF BUILDING
Front Depth? Height Stories, Manner of Constriction
f
To be used as ": :fir•'* To be Completed ` —, ` Estimated Cost L
i
Permit is hereby granted to
the building`'" described in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Inspector of Buildings.
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridlev of
the above permit,;, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
• sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated.
i
Subscribed and sworn to before me at Fridley, Minnesota, this
-
day 1
da ofa��pi A.D. 19_4!k-
w-
City of Fridley, Minn.
BUILDING PERMIT N® 4 2 4 5
Date: _.55._M:.....:- .._....- - .91----1. —59.._.._ ..................................
Owner:-....��tS'' fnna211.ey-1........BleZ'.Iiat....--------------------.... Builder ..... ...................... Owne.>-------- -•_....... -.._------------ __ ....._....._..... -----
Address ... `rod' .__ .._F -r _._.......... Address _........_..._..... - -............................ .................
Minneapolis, Minnesota
LOCATION OF BUILDING
No. .... `i'o 3 - Street W. -Ott tt .......................................----.....----.. Part of Lot ............. --.......... ----............................. .........
_
Lot ...116.-1 ........... Block ............. ............. 3 .................... Addition or Sub -Division ............. p17mou h........--...----......__.............--.--..-....._....
CornerLot .........................._ ........ Inside Lot ---------------- ------------------ ..- Setback .......................................... Sideyard .................---------------..............................._...._.....
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
d� -.........
Front .....-1 � Depth ......... - �. Height ...._ .�......-.. Sq. Ft...._l 'O._.. Cu. Ft. ...3-120
..._.............._...................................... Front ........................ Depth ....................... Height ........................ Sq. Ft. ..... _................. Cu. Ft. ..............
.........
Type of Construction...._....�`�P. M6.................... - Est. Cost ....1t.831.-.. .......... .............. 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 city of Fridley. -- 4- 'n ,_p ,) - --j- A
In consideration of the payment of a fee of $...._1'F'.s.. ............ 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
within the city 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 for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
City of Fridley, Minn.
BUILDING PERMIT N® 4 3 4 5
Date: .....-•-L.. / - .L....._`......_.- _... —..............
P/Owner: _. ....- `..... ....._........_..._.................... Builder ....._...._.... .. --^
Address................... ........ ..... ........ ......................... _._ ___..._._.._........... ..... Address ................. ..-
O TIO BUILDING
No..... Street . - .._' ._.....__.................. .............................. .............. ......... ..... Part of Lot ............. ..................... ......... -... .............. - .............
_....
Lot....._...L- IV ................. Block .............. ..................................... . Addition or Sub -Division ..... - .................................. ........--••------....._..........................._....--•---------.
CornerLot .............. ........ ............ Inside Lot ..... _ ................... ............ Setback ...... -----............................... Sideyard .................... .............. _............._...........---...........
Sewer Elevation ..... . .............. ............................. _............. _......... ............. ....... ....... Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
eO q w a roi //
.._.._...::... .. Front ...._ Depth � 77.... ® Height .. .' . .. Sq. Ft. ... _.. Cu. Ft. 6�.._3...
.......................................... Front ..................... Depth ..._....._........ Height .......... Sq. Ft......................... Cu. Ft........................
Type of Construction . ................................ ...._._.....__..._.... Est. Cosi`.'....... ®� ............ 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 city of Fridley. m
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
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. l—
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
City of Fridley, Minn. No 10207
BUILDING PERMIT
Date: April 30, 1969
Owner: Mike Tuzinski Builder Same
Address 4803 2nd S t . N . E. Address Same
No. 4803 Street
LOCATION OF BUILDING
2nd S t . N. E. part of Lot
Lot 16 & 17 _ Block 3
Corner Lot Inside Lot
Sewer Elevation
Addition or Sub -Division ..Plymouth Addn.
— Setback -- Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Alda . t o House Front 12' Depth 16 ' Height _10' Sq. Ft 1-92 Ca, Ft. 23 04
Front Depth Height Sq. Ft. Cn. Ft.
Type of Construction Frame Est. Cost 4 -00Q=00--- 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 city of Fridley.
J
In consideration of the payment of a fee of $ 5.00 , permit is hereby granted to Mike Tuzinski
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 andmoving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Q
Clarence Belisle
NOTICE:
Uk permit does not cover the construcdon, installation for wiring, plumbing, gas heating, sewer or water. Be wee to see
the Building inspector for separate permits for thew hams.
APPLICATION FOR BUILDING PERMIT
4� f'. -5-s'
CITY OF eMINNESOTA
i l
OWNER IS NAME277��- -BUILDER
/r
DD. �ADD. 0
t�6 LOCATION `OF BUILDING
NO. STREET 2 - �%Z
LOT Z BLOCK ADDITION OR SUBDIVISIONS �.
CORNER LOT /r INSIDE LOT SETBACK SIDEYARD____T_
SEWER ELEVATION TOP OF FOOTING
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: Zea
Front Depth Height
Square feet % Cubic Feet
Front Depth Height
Square feet Cubic Feet
Type of Cons true tion jP R,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 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
e true and correct.
DATE � `3 0 e SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side.)
C-/
61
. ,,
... e.
/FIRE DEPARTMENT MEMO
TO: BUILDING INSPECTION
ASSESSING
SUBJECT: FIRE DAMAGED STRUCTURE
FIRE HAS OCCURRED AT
- znd St
NE
December 22
DATE F FIRE 984 19:56 a.m.)
FD- 7
DATE: December
26, 1984
SUBJECT
PERMIT NO.
City
of Fridley
WRECKING
17 8 3 7
AT THE
TOP OF THE TWINS
0"004a PERMIT
RE
16v -------
COMMUNITY DEVELOPMENT DIV.
S-�
r
PROTECTIVE INSPECTION SEC.
1�
1 �
`
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
1/8/85
JOB ADDRESS 4803 - 2nd Street N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
16,17
3
Plymouth. Addition
SHEET
2 PROPERTY OWNER
MAILADDRESS
ZIP PHONE
Michael Tuzinski 4803 - 2nd Street N.E.
572-8916
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
Garage
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ MOVE
Cj REMOVE
/FIRE DEPARTMENT MEMO
TO: BUILDING INSPECTION
ASSESSING
SUBJECT: FIRE DAMAGED STRUCTURE
FIRE HAS OCCURRED AT
- znd St
NE
December 22
DATE F FIRE 984 19:56 a.m.)
FD- 7
DATE: December
26, 1984
Effective Aug. 1, 1981
City of Fridley
Permit No.
rP AT TME TCW " THE T'R'INE
WRECKING PERMIT APPLICATION
Receipt No.
r L-------c0w"iTT OEV[LOPMENT OW.
I i PROTECTIVE NVECTi" WT.
C9W MALL FlUOLCY 964N
.w-&"-3"0MJIBR
EV.
DATE
211517-4
IME p+A"*0V1nD
1 1
BY
An
Job Address q 9 d
3 l 1 14 n 3' d
Legal
Lot No.
Block No.
Tract or Addition
Desc.
l� -- 7
r1 Pito u ly-)0'11
Property Owner AddressPhone
II
stn
® -5 --c Y A 5- i -�- i-`/1!
Contractor Address Phone
Description
Front
Depth
Height
Sq. Ft.
Cu. Ft.
of Bldg.
IG -
No. of Dwelling Units
Taxes Paid
Tax Receipt No.
&r
Estimated Cost of Wrecking
=To Completed
Utilities to be Notified and date Services Disconnected
Mpls. Gas Co. N.S.P. Northwestern Bell Tel. Co.
Sngr. Dept. Cust. Bus. Ofc. Bus. Ofc.
372-4850 330-5540 332-4112
Date Date Date
Wrecking Fees: $1.25 for each 1000 cubic feet or fraction
For structures which would be impractical to cube, the fee
shall be based on the total cost of wrecking such structure
at the rate of $6.00 for each $500.00 or fraction.
MINIMUM FEE: $15.00 No State surcharge on Wrecking Permits.
Approved By Water & Sewer Department:
All Bills Are Paid Services Are Disconnected
The undersigned hereby makes application for a permit to wreck the building
described above, agreeing to do all work in strict accordance with the City
Ordinances and rulings of the Department of Buildings, and hereby declares that
all facts and representations stated in this application are true and correct.
i C; C; Contractor
Date
3
. C'Ca
.r
FIRE DEPARTMENT MEMO
T0: BUILDING INSPECTION
ASSESSING
SUBJECT: FIRE DAMAGED STRUCTURE DATE: POO Jan. 16, 1985
FIRE HAS OCCURRED AT
4803 - 2nd St.
Dec. 22 1984
DATE OF FIRE
FD- 7
P
SUBJECT P
City of Fridley
17 9 3 9
AT THE TOP OF THE TWINS
BUILDING PERMIT
Ir?�
CEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
INSPECTION
PROTECTIVE SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
----/"','�
L 612-571-3450
910-F15
4/30/85
JOB ADDRESS 4803 - 2nd Street N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCA
16-17
3
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Michael Tuzinski:. 4803 - 2nd SrXrNVMX Street N.E. 572-8916
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
X
8 DESCRIBE WORK
Construct a 24' x 24' Detached GAr4ge
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide at hard surface driveway.
SEPARATE PERMITS REQUIRED FOR
WIRING, HEATING, PLUMBING AND SIGNS,
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
SO. 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
1 HEREBY CERTIFY THAT 1 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
$7,021
$3.51
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-
$68.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
..
$72.01
SIGNATUREOFpCONTRACTOR OR -AUTHORIZED AGENT IDS EI
WHEN PROPERLY �LIDATED THIS 1S YOUR PERMIT
Li1\�
BLDG WSP naTE
SIGNATURE OF OWNER IIF OWNER BU;FC P ERI (DATE) -
P
NEW [C",/ City of Fridley Effective 4/1/84
ADDN. I J R-1 AND R-2
ALTER. I J Building Permit Application
Construction Address: U ---5 -- C>6 rVal I c r, I � ` �-
Legal Description: �� �� - EZI
Owner Name & Address: b,].b tc� � i� �, l S pr( i E -P 73 — Ci vA Tel. #
Contractor: 5 -QM Tel. #
Address:
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
Length Width �� Height
Length Width Hgt/Ground
Corner Lot [ J Inside Lot
Type of Construction: 112
Approx. Completion Date: _.
Proposed Driveway Width If
1� c�
DATE: K� �® �- �S APPIV1 -7
Sq. Ft.
Sq. Ft.
Sq. Ft.
Setback
A/
Alt B
a
planation
Permit Fee $
Plan Check
1
State Surcharge
SAC Charge
Park Fee $ g
Sewer Main Charge $
Necessary [ J
TOTAL a
STIPULATIONS:
SUBJECT
PERMI1T NO": - -
of Fridley
'"
933 � 3 t
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
Ir?City
� • COMMUNITY DEVELOPMENT DIV,
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
�""""�� ,•�
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/2/95
JOB ADDRESS 4803 2 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR,
16,17
3 1
Plymouth Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Mike Tuzinski 4803 2 Street NE
572-8916
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 Cj REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof 1/2 House (5 Sq) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd but not the 3rd layer.
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 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
ISTALLS
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
$.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$275
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-
Fire SC $.28
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$15.00
PLAN CHECK FEE
TOTAL FEE
$15.78
SIGNATURE OF CONTRA R OR AUTHORIZED AGENT IDATEI
WHEN PROPIPARY
VALIDATED THIS IS YOUR PERMIT
BL G INSP
T/ TE
S� NATUR�OF OWNERUF OWNER LDERI (DATEI
NEW f 1
ADDN
ALTER
Legal Description:
Owner Name & Ad4
Contractor:.
Address:
e
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 1/1/95
TeL
MN LICENSE #
Tel.. #.
Attach to this -application, a', Certificate of'$urvey of the _ f
lot, with. the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER:
Comer Lot ['I Inside Lot [ 1
Type of Construction:
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft t x $ a = $
DATE• �� APPLICANT: ,> e Tel. # T1 -
3
CITY USE ONLY
Ft. Yd Setback
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
r__,/ _.so ® _ � __o , - 'tel
Side Yard Setbacks
Estimated Cost: $
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
— Lei)
$ Z'�
Fee Schedule on Reverse Side
$
.001 of Permit Valuation (1/10th%)
$ ay
$.50/$1,000 Valuation
$
$850 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 ( ]
Building
PLUMbING
PermitNo.00C 7 UOZf
Inspections
RESIDENTIAL APPLICATION
received By:
763-572-360' •
CITY OF FRIDLEY
D6'&'dk U N 2A�
DATE o�� YOUR E-MAIL ADDRESS
SITE ADDRESS Qbl
THIS APPLICANT IS: 0 ORINER O ONTRACTOR
PROPERTY
NAME:.
OWNER/
ADDRESS: CITY vIA l, _ STATEd&' ZIP;
TENANT
PHONE: 01t) C111!/1�' Ml ll ,
CONTRACTOR
Nom;: a no fii-
SUBMIT A COPY OF'
J N WA =® gnwuW DATE
STATE LICENSE CHAMPION
YOUR STATE
ADDRESS: 212 N. River Rldge Cire� CITY STATE ZIP
LICENSE WITH
���/ c umsville, MN 5 7
PHONE 6�rii a r ��I
APPLICATION
PERMIT TYPE
C[YBINGL E FAMILY 0 TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
ONEW IqVREPIACEMENT
DETAILED DESCRIPTION OF WORK ,,
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, forbe
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 AREBASED ON f1o.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) ' .
BATH SINK/LAV FLOOR DRAINS SHOWER _ WATER PIPING
GAS PIPING pvUD qTP ) _-SWIMMING POOL _ WATER SOFTNER ($35)
—BATHTUB _
CLQTH;ES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15)
_ _
LAUNDRY TRAY ]E VATER HEATER ($35) FOR IRRIGATION
_'DI3IiWASHER _
a _ WATER METED _ OTHER
.. ..
".OVER�$500"
Permit Fee $ '�,;b Number of fixtures @ $10.00 x$10.00=$
Surcharge .56 Number of fixtures @ $15.00 x $15.00 = $
TQTAL DUE $ G`)6 `��' Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
i THIS IS AN APPLICATION FOR A PERMTr-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 perTit�but only an application for a permit and work is not to start without a hermit; that the work will be in accordance with the
approved plan in the case of all irk which requires review and approval of plans.
SIGNATURE OF APPLICANT �' �� fl PRINT NAME �I DATE V ole, OI�
UU� J
♦� '�� �y
- City of Fridley
Building Inspections Departments
6431 University Avenue NE, Fridley, MN 55432
763-5723604
' V A v. X41 cnn AWV7