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PRE 2010 DOCSIF V SUBJECT PERMIT NO. City of Fridley X85 AT THE TOP OF THE TWINS PERMIT i BUILDING T -W COMMUNITY DEVELOPMENT DIV. �j r PROTECTIVE INSPECTION SEC. O?C?Vogl CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY., 612-560-3450 910-F15 1/24/75 JOB ADDRESS 6001 2nd Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR: 16,17 7 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Smrskovi 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Amber Construction Inc. 6070 Stinson Boulevard N.E. /3 4 -) 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USEOFBUILDING Residential 7 CLASS OF WORK Ij NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 40' x 26' Duplex and a 30' x 22' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a verifying survey before capping. Provide a hard surface driveway and parking stall. Provide 1 hour fire separation between units. SEWER LOCATION: 68' North of Manhole (Inv. 845.61) Wye Elev: 845.34 Top of Footing: 848.84 Minimum WATER LOCATION: 59' North of Manhole, 9' South of Sewer Service SEPERATE PERMITS REQPiRED 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 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 R-1 1040 20,576 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 2 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $40,038 20.02 DOES NOT PR SLIME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CI�.A- - PROVIS F ANY OTHER STATE OR LOCAL L REGULATING CON- qFF n5.00 STRUM OR THE PERFORMANCE OF N T ION. $51.00 PLAN CHECK FEE 4121 TOTALFEE $396.02 SIGNATURE OF CONTRACTOR ORAUTHO EDA NT DA WIJEN PRO E�DAHIS I OUR PERMIT VGNATURE OF OWNER (IF OWNER BUIL (DATE) DG INSP DATE IF V R APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAM: BUILDER: ADDRESS • ADDRESS: IW O NO:. �`"" F_ STREET:— LOT: TREET•LOT: 14 -1-17 BLOCK: ADDITION CORNER LOT: INSIDE LOT: SETBACK:I m� SIDEYARD: F 3 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: -2 Height: Square Feet :,& Cubic Feet: `Front : Depth: • �-- Height: I r Square Feet; Cubic Feet: 7 Type of Construction: Estimated _Cost: $ V! j:d06 To Be Completed: 7 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 th applicat n are true and correct. ( 2_ _- DATE: SIGNATURE: ' (See4,3everse Side For Additional Information. VI ' GERALD T. COYNE 300 BRUNSWICK AVE. S. GOLDEN VALLEY, MINN. MINN. REG. NO. 4741 ;i. INDUSTRIAL — JUDICIAL COMMERCIAL — TOPOGRAPHICAL CITY LOTS — PLATTING AMBER C01,413TRUCTIONT J' c"s CAUTI **M&WWON LOT SURVEYS COMPANY RAYMOND A. PRASCH" 6917 IDAHO AVE. N. LAND SURVEYORS BROOKLYN PARK; MINN. MINN. REG. No. 6743 REGISTERED UNDER LAWS OF STATE OF MINNESOTA LICENSED BY ORDINANCE, OF CITY OF MINNEAPOLIS 5747 W. Broadway Minneapolis, Minnesota 55428 533-9922 INVOICE No. 4633 F. B. NO. SCALE I,- 0 — DENOTES IRON N 0 -Denotes 44. 3 I -C-- Wood Huts N -6 For Excavation A Only a 3L p Elevation dauum assumed, C3 Q) + r4 WV qww RawOFKAGA ANY. VNIMIN7968 AREA "OUT' AP. i N FRIDLEY. 'o "W*LW7HE CITY F E' 7- i� z / 19 69/ Lots 16 and 17,` Block 7, Hyde Park, Anoka County,, Minn. IlWe hereby certify that this is a true and correct representation of a survey of the boundaries of the above Azz, described land and th® location of all builldings and visible encroachments, if any, from or on said land. Sig e m - e r ig 74 ned . LOT SURVEYS CO . MPANY Surveyed by us "this day of Der- f57 d (' cj e C ip7c' ' ^" w F%:ft and "ccmung, ffi aU sz �a armas t a r a Airw =1'ai: SYMMS ozd Dem GRAVITT WARM, AM: RATE TOTAL. Furnitce Shell & Durt Work $10.00 'r`l— Replacernent of rurnart 6.00 $ Repairs & Atterat:ons--up to $500.00 600 $ Repairs & Alterations each add. $500.00 300 $_ FVxnaee Shell & Duct Work to 129,000 BTU .11000 $ each add. 60,000 BTU 3.uU $ Replacement of Furnace 6.00 4 Repairs & Alterations --up to $500.00 6.00 8 Repairs do Alterations each add. $300.00 3.00 $ STEAM at HOT WATER SYSTEM Furnace Shell & Lines ---to 400 sq. ft FZR Steam $10.00 $ rurnace Shell. & Line- --to 640 sq ft. EDR Hot Water 1000 S. Each add 201 sq. ft. EDR Steam I'm $ Each add. 320 sq. ft. EDR Hot Suter 3.00 $ OIL BURNEP—to 3 gaL p -2r hour 6,00 $, over 3 gal. per hour --See Fee Schedule GAR BURIMR (up to L*9,1W BTU) &00 $ over 199,000 B`IU fame Fee 3cbedule CAS FITTING FET -3. NO RATE TOTAL lst 3 Futures x� 200 8 Additional Fixtures _ x ,76 8_.. • _ Gas Range to IN.OW 235.00 $ c r. /-29—i� State Surcharge .50 is" At Foe sc TOTAL Dept. of B1d0SSM-UM .A" 6 0 I - _-2 City of Fridley: The undersigned hereby makes application for a hermit for the work hereW. specified. agreeing to do all work in strict accordance with the CIty Orifiumices and ruling of the Depa?tment of Buildings, and hereby declares that all the facu and representatiuns stated in this application are true and correct. Owner Kind of Used as I*n_ Fridley. MJnn- To be completed about)) Estimated Cost; S ,2A Old—New. Building Permit No. _.—_ i Permit No.— HEATING or POWER PLAN75--1 Mans, Not Water, Warm Air --No— Z Trade Name--�a�G�size NO l� Capacity.._. _. Sq. Ft. E.D).R BTU iP Total Connected L and .oc Kfnd of F�x BURNER — Trade Nam Size Ilio uses-0VM 3 9 SLO�i;,gip �a•g��"'�1�'tP�9a 84 P� 1 City of Fridley . Applicelan for Plumbing and G= M."ingit Dept. of Bldg*. Phone M-3450 DESCRIPTION OF WORM ° Number, hind and Loee3ien of Fixtures � Q � V, o NO. RATE TOTAL z D x $2.00 $ 20-02 Future Fixture Opening .. ....... o 7 a 7 z gg o a e N WATER HTR. GAS EIEC. Catch Basin .................... f x $3.25 $ Water Heater !Up to 99,000 BTU).... 1 x $3.00 $ -3-OU New Ground Run Old Bldg. ........ x $3.25 $ Electric W&tar Heater ............ . a $2.00 a GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ............ • • • • • • x $2.00 Additional Fixtures ............... Base $ I 1 x $5.00 $ 2nd _ rd4th3rd.- 4th Future Conn©ctloa Openings $ Now Fixture, Old Openings PARTIAL RATE SCHEDULE sever Cesspool PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ D x $2.00 $ 20-02 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).... 1 x $3.00 $ -3-OU New Ground Run Old Bldg. ........ x $3.25 $ Electric W&tar Heater ............ . a $2.00 a 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 $ City of Fridley: The undersigned hereby makes application for a permit for the wort herei specified, agreeing to do all work In strict accordance with the Cib 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, b9nn- !�,�f, � � / 19 Owner _ eq 7 Kind of Building Used as Lo L To be completed about Estimated Cost, $ Old ew Building Permit No. Permit No. r ROUGH FINAL REPAIRS tE ALTERATIONS --Refer to Code .50 State Surcharge De=iption ...................... T(YrAL FEE $ �� �� Signed '-Va 6� By, Business Phune S60-3450 ' Cit ���. 1� :a • ANOKA COUNTY 6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55421 August 6, 1975 Amber Construction " 6001 - 2nd Street N.E. Fridley, MN 55432. Re: Verifying Survey for 6001 - 2nd Street N.E.e Gentlemen: - Please be advised that of this date, we have not received a verifying survey for the above captioned house. We would appreciate it very much if you would get this survey into our office no later than September 1,. 1975. Thank you for your cooperation in this matter. Yours very truly, DARREL CLARK Community Development Administrator ' DC/cs September 4, 1975 0 w a M O LQ N tp • Amgrid Development Inc. U 169 Silver Lake Road Ln New Brighton, Minnesota 55112 Lo4 F- 0 Re: Final Inspection at 6001 - N W ZDear Sirs: 2nd Street N.E. A final inspection was made on August 29, 1975 of the above address. JThe following items were noted and must be completed before the o construction can be finaled out, LL L. Submit to this office a copy of the verifying survey. s 4 2. Install closer on door between the house and garage. W 3. Install joist hangers on.deck. M z We will expect items 1, 2 and 3 to be completed by October 3, 1975. W If any problems arise that will prevent you.from completing these Zitems by the appointed date, please contact us. w 4 A reinspection will be conducted on or about October 3,.1975 to determine compliance. LU Sincerely, • Fq-- DARREL G. CLARK W Community Development Adm. N W DGC/mh U U > P.S. Please have the Electrical and Plumbing Contractors call in for 5 their final inspections if it has not been done. SUBJECT PERMIT NO. City of Fridley ® 19373 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. lJ 1 i i 1 /---1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/4/88 JOB ADDRESS 6001 - 2nd Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 16,17 7 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE XMIXX Judith Downing-Rickhoff 574-0019 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 EA ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Construct a 161 x 161 Addition to Dwelling (3=Season Porch_) 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMITS 0��� � REQUIRE® F ir,--ATING P� R 1�q IAB1NC AND SIGNS. 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 OFF5TREET 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 $12 000 $6 �� WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT / DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS FANY OTHER STATE OR LOCAL LAW CON- $92.50 STRUCTION ORTHE PERFORMANCE OF CONSTRUCTION. ONEGULATING LAN CHECK FEE TOTALFEE $23.13 $121.63 S;IGPgATURE OF CONTRA R OR AUTH RIZED G T D TE) 1 EN PROPERLY VA ATED THIS YOUR PERMIT 6 SiSlqATTREOF OAMR0F OWNER BUILDERC44,of(DATE) BLDG )NSP pT NEW [ ] City_ of Fridley Effective 4/1/86 ADDN. F R-1 AND R-2 I. ALTER. [ ] Building Permit Application Construction Address: 6 00/ ��� _� Fr' l le � Legal Description: yc1�e 19ar % 164S %6 " /7 Owner Name & Address: ��d �j �' Dewl)i��d /0-9 Tel. # Contractor: f/e11 by Z ' 11e'O1h 14 i �1k�� �'7� Tel . If Address: i -V' _' 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. Length 16 Length Length 16 ti DESCRIPTION OF IMPROVEMENT r Width �r<o Height 91�r�'eSSq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. q!-�� /016:-��C�'� l •� Corner Lot 54 Inside Lot [ ] Ft. Y( Setback Type of Construction:-1AJ&ocLA*y ►L0— Approx. Completion Date: 10/9? tI13r? 3.91 Yard Setback Estimated Cost: $ 193F-.� Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: N $ $ See Back Page for Explanation DATE: Al- �" 00? APPLICANT: el CITY USE ONLY Permit Fee $ 90.5o Fee Schedule on Reverse Side Plan Check $ Pl:S 25% of Building Permit Fee State Surcharge $ `�� $.50/$1,000 Valuation SAC Charge $ $ 550 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ �` ° Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: l �� j a L SUBJECT - P MIT NO. , City ®f Fridley 900 AT THE TOP OF THE TWINS BUILDING PERMIT ' ' rr DEVELOPMENT DIV. RECEIPT � `L ______ COMMUNITY r PROTECTIVE INSPECTION SEC 1 ;'� CITY HALL FRIDLEY 0432 NUMBER REV DATE PAGE OF AOPROVEO By L 612-571-3450 91 0-F15 5/4/00 JOB ADDRESS 6001 2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 16,17 7 1 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Christopher Kalla 6001 2 Street NE 586-0693 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 Duplex 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Duplex and Garage (27 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OFC NST. OCCUPANCY GROUP OCCUPANCY LOAD 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 2 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 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT $2,360 $1.18 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 HE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEETOTA FEE 6.79 SIGNAT CON:RACTOR9F.!UTHORIZEDAGENT IDATEI EN OPE INSP ALIDAT THIS IS YOUR EERMIT D� BATE S-GN RE OF OWNERI,F OWNER BUILDER, IDATEI L NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �® BUILDING PERMIT APPLICATION �a Construction Address: �j Legal Description: /� Owner Name & Address: _ c..,,ky 4o��►&r T. 4w(& Tel. # J96- 6(093 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: Length Width Hgt/Ground Sq. Ft. OTHER: '-evoc+ 10a5Z a-. '-'arace' cwt ' arc Z-1 S9uA.r'OS Construction Type: Estimated Cost: $i 6 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE:APPLICANT: C�Y]5 � � �- �"" Tel.# 586-0&a3 CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ Fee Schedule on Reverse Side- ideFire FireSurcharge $_ .3 .001 of Permit Valuation (1/10th%) State Surcharge $.50/$1,000 Valuation SAC Charge $_$1 100 per SAC Unit License Surcharge $ $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 $ (�•2 STIPULATIONS: Building PL UMBING Permit No . Inspections 1ESIDEN'I`UL APPLICATION Received By:lA_ 763-572-3604 CITY OF FRF DLEY Dat 763-502-4977 FAX EFFECTIVE 1-1-08 DATE � � � � !/� X YOUR E-MAIL ADDRESS THIS APPLICANT IS: ❑ OWNER WONTR.ACTOR PROPERTY NAME: `l ADDRESS: CITY STATE ZIP OWNER/ TENANT PHONE: CONTRACTOR NAME:rq g��q STATE LICENSE # r'Xo �? EXP DATE SUBMIT A COPY OF YOUR STATE D LICENSE, BONAND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: Y11 K 4. J/C CITY `i STATE 1`w.ZIP Llf INSURANCE PHONE (? It 3 7 3 -7 FAX Le e 2 - '1 PERMIT TYPE gINGLE FAMILY O TWO FAMILY O TOWNHOUSE TYPE OF WORK: o NEW Off REPLACEMENT DETAILED DESCRIPTION OF W ORK 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 = plus .50 surcharge OR FOR PRO.IECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10..000 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEL $15.50. WATER PIPING BATH SINMAV DRAINS —SHOWER - _FLOOR - BATHTUB_ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) WATER CLOSET BACKFLOW PREV. ($15) _CLOTHES WASHER _ KITCHEN SINK _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION WATER METER —OTHER Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .5 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ 10 OR Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 INIMUM $15.50) (MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 permit but only an application for a permand work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case w ich re u' eview and approval c plan . SIGNATURE OF APPLICANT PRINT NAME 3-.0 DATE APPROVED BY City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 DATE M !'' 11 orf' 11 `I I:r: • V• Is. Tj1 �1' • • Y' ' 1 • M:I `i �+' •i�'� • " • kMll' • �1 X11 :r. • A. ZONING ALTION: ORDIl NO: B. SPECIAL USE PERNIT(S): # C. LOT SPLIT(S): # D. VACATION (S) : C,�® ( , 01WE9 NCE ND: E. VARIANCES APPEALS COMMISSION: APPROVED DISAPPROVED - DATE NO. CITY COUNCIL: F. EASEMEMS: Bikeway/walkway Street right-of-way Utility Drainage Alley Other (Specify) G. LICENSE(S) (List)`: Date of Renewal: H. STIPULATIONS (List): DATE REQUIRED DATE COMPLETED I. MISCELLANEOUS: