PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
N° (�5853)
Date:
Owner: + Builder _
Address _ Address
s`
N F JUJILDING
Na i( / &4L Street _� _ parkoewl"M .09
Lot_ Block - , Addition or Sub -Division -
Corner Lot , Inside Lot Setback Side d
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
Tod jov
_ _ Front„ _ Depth _ Height , Sq. Ft. 41,406u. Ft �v
Fron j;� Depth eight Sq. Ft. Cu. Ft
Type of Construction/lf..` Fast Cos �,,........ 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.
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 su work
done in, around and upon said building, or any per_thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota reg location, construction, alteration, maintenance, repair and moving of buildings
within the city limits an� permit may be revoked at`any��1��viola�,iarn*{�f any of the Provisions of said
ordinances. AX
Inspector
NOTICE:
This permit does not cover the construction, hrstaBation for wiring, plumbing, gas heating, sewer or water. Be sero to we
the Building Inspector for separate permite for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name�ilder
Address�/7/•Address
LOCATION OF BUILDING
No. Street ` ,�_ Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
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:
�JLvz � Front Depth 16 Height fly
Sq. Ft. Cu. Ft. �at?
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cos
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 true and correct.
11 1
/ ��/
�e-_��/S►-s
(Schedule of Fee Costs can be found on the Reverse Side).
.1 0 0
Nl✓W , [ ] Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 14 b -3c.c4-�
Legal Description:
Owner 1\
Contract
Address:
Tel. #163-57��l�6�
MN LICENSE # j'7 q
Tel. # (06'(-7W LI ` 2a 4,6
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:
Construction Type. Estimated Cost: $ -�/•
(Fee Schedule on. Back)
Driveway Curb Cut Width Needed: Ft. + 6 At = Ft x $ _ $
DATE: • d��d-� ` 0 �- APPLICANT: Tel. #W-7 9
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY
$ Fee Schedule, on Reverse Side
$ !a,00 .001 of Permit Valuation (1 / 10th %)
$ Lt. 15-- 0 $.50/$1,000 Valuation
$ $1050 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 [
STIPULATIONS: D�
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