PRE 2010 DOCSMage Of Fridley, Minn.
BUILDING PERMIT
DESCRIPTION, OF BUILDING
Front -f DeptJ3 Height stories Manner of Contra
To be used as To be completed ` " Estimated Cosi �e*.e
Permit is hereby gr ted toy`-AZOCAM .,-' fl- to �,` •��-K*°�'' -'
the buildtaw described in the above statement. This permit is granted
upon the express con Ition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, aj nmd.and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, 3 Wn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limiti and this permit may be revoked at any time upon violation f any of the provisions of said
ordinances.
—Inspector of Buildings.
r
AGREEMENT AND SWORN STATEMENT
In considerat on of the issue and delivery to ,me by the Inspector "of Puildings of Fridley of
the above permit, I hereby agree to do the proposed work in accor&mce with the description
above set forth d according to the provisions of the ordinances of Fridley; and, being first duly
sworn, I hereby ate and say that the facts stated by me and contained hi the above permit are
true as therein ted.
Subscribed and ora to before me at Fridley, Minnesota this '
i City of Fridley, Mian.. 0
BUILDING PERMIT N® 4320
......._— �Date: ...--......�"......._..._........1
.. .---.............---
Owner::/`� . _._ ..... ................... Builder it n
Address..... ........ ........... .._...._.............----•-----.___. _.---. __._..__.......... Address
�// TI N OF BUILDING
No..... dl.... ... .Street ....._.... .................... .... .... _................ ....................... Part of Lot
Lot ...................................... Block ..... -....... ..... _................................ Addition or Sub -Division
Corner Lot .................................... Inside Lot..,X............................. Setback ............................................. Sideyard
Sewer Elevation ..................................... ............ -..................................................... Foundation Elevation ..................
DESCRIPTION OF BUILDING
To be Used :
_........................................... Front �� Depth .1......... Height ... Sq. Ft. --.z Cu. Ft. 1...
......__......................................... Front --- ------ - Depth ............ Height
��..__..........__.. Sq. Ft......................... CU' .Ft. ........................
Type of Construction ._.......--. ...................... ............ Est. Cost....../�.._..... 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 fo , and in copliari j.,with all provisions of
ordinances of the city of Fridley. ��// �4
In consideration of the payment of a fee ofpermit 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. _ice
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 hems.
City of Fridley, Minn. NT 9 3 3
BUILDING PERMIT
Date: Sept- S, 1967
Owner: George Steer Bid" George Sponger
Address 4868 3rd street N.E. Address 4868 3rd Street P.E.
9
LOCATION OF BUILDING
No. 4868 Street 3rd Street N.H. part of Lot
Lot 3 & 4 Block- Addition or Sub-Divisionft outb Addition
Corner Lot ._ Inside Lot Setback __ _ _ Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: Garage
Front Depth Height — Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. — Cu. Ft.
Type of Construction Fat. Cost _ S 1, 25 Q ___ 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 ;h provisions of
ordinances of the city of Fridley.
r
In consideration of the payment of a fee of $ 8.00 , permit is hereby granted to GeOWO
Spanc®r
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.
Ldly
ces.
CL RUNCE BAISLE Building Inspector
NOTICE:
als permit dose not cover the construction, Installation for wking, plumbing, gas heating, awn or water. Be sure to dN
the Building hopector for separate pormhe for thea hum.
1117 r`1•- 70 IN PSI'
CITY OF nI YDLEiy Ai NNE SCTA
OWNER'S NAME- Bii�'�,tDER _
ADDRESS ' /1 ' - - -- -- -- ADDRESS""A�,LL�
LOCATION OF BUILDING
N0. _SVREET PART OF LOT
LOT BLOCK ADDITION OR SUBD:VISION
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 draum on these Certificates.
.DESCRIPTION OF BUILDING
To Be Used Ad:
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
�j Sq. Ft. Cu. Ft.
Type of Construction Es Cos t
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.
DATE SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
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SUBJECT
PE1707
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
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REC NO.
�
COMMUNITY DEVELOPMENT DIV.
10233
r i � PROTECTIVE INSPECTION SEC.
1 �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910-F15
July 28,
1483
JOB ADDRESS
4868 - 3rd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3 & 4
2
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
George Spencer 4868.- 3rd Street N.E., Fridley, M 55432 572-8901
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Dalberg Builders 1121 - 80th Avenue N.E. Spring Lk.Pk. MN 55432 784-2720 17071
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO,
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION? ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroofing & Framing
I
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
f
gooas
It
VENTILATING OR AIR CONDITIONING.
ph
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
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
$5000.00
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-
$56.50
$2.75
STRUCTION O HE PERFORMA OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
a
$59.25
SIGNATUREOF CONTRACTOR OR AUTHORIZED AGE It(DATE)
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WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG INSP GATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (D EI
CITY OF FRIDLEY
Effective Aug. 1, 1981
APPLICATIM FOR RESIDENTIAL BUILDING PEFU41TS
(New, Alterations, Additions, or Repairs)
01111ER: f Z BUILDER:
ADDRESS: 3 s ADDRESS:
TEL R0: TEL NO: -:2,0
Construction Location
• STREET NO: STREET: '�V F_
LOT: 72 r BLOCK.: ADDITION:
Corner Lot: Inside Lot: K Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
"OYDESCRIPTION OF CONSTMI CTION
ronk: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction:
Rb Be Coripleted: — 3 lip —
m.
Estimated Cost: $
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ ' $
SEE FEVER�E SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the %.nrk herein specified,
agreeing to do,all work in strict accordance with the City of Fridley Ordinances and
rulings of the Delxirtment of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE:z I ���� SIGNATUIE :
SU'pulatio
ZS6eS_U
v ` 1
SUBJECT
PERM
City of Fridley
19 0 3 8
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
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R
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
_
r
1 �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
�"'"Jl/
612-571-3450
910-F15
6/29/87
JOB ADDRESS 4868 - 3rd Street N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3,4
2
Plymouth. Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
George Spencer 4868 - 3rd Street N.E. 572-8901
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 JJ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 121 x 41211'.Baaement Entrance
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan
WARNING
Beim digging call local util O
EEECT11c, W ttt-
TELEPHONE -
SEPARATE PERMITS REQUIRE® F017
le utR® PI LAIN
1 1.
' c
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
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
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
$1100
$.55
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-
$19.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$4475
$24.30
SIG�TUREON TOPOR AUTHORIZED AGENT IDarEI
WHEN PROPERLY DATED TH S IS YOUR PE IT
IBLOG
SIGNATURE OF O ER F NER BUILDERI I ATEI
INSP TE
v ` 1
NEW [ ]
City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
ALTER. Building Permit Application
Construction Address: �i 6 �irc� -sem ` rV �
Legal Description: S i Ocve Ilr`n
Tel. #
Owner Name & Address:
Tel. #
Contractor:
er
Address: qJ01PA173rcQ S�• N.
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING
GARAGE
-DBe*—Afj*AsLength
AREA: Length
AREA: Length
la
Width -
Width -
Width q -d''4_ 2 gin.
Height Sq.
Height Sq.
bj Sq.
Hgt/Ground j�
Ft.
Ft. _ -
Ft.
OTHER:
�it amee-
Corner Lot [ ] Inside Lot [✓]
Type of Construction:
Ft. Yd. Setback
- Side Yard Setback -
Estimated Cost: $ 110 0 cc -
Approx.
Completion Date:
Alt. A
Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE:
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
APPLICANT:
CITY USE ONLY
Tel.
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$ 525 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
1 oo ,v1
SUBJECT
City of Fridley
26182
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECRE I
i ♦y ������, COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r � �
1 . i
NUMBER'
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
6/9/98
JOB ADDRESS 4868 3 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3,4
2
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
George Spencer 4868 3 Street NE
572-8901
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
O NEW Cj ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 12' x 11' Deck; Install patio door
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan.
WARNAg
Before digging
cep for
all utility locations
REQUIR02
ED°B Y LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 1 HAVE READ AND EXAMINED THIS APPLICATION
1
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
$1,184
$.59
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
PROV S OF tNY OTHER STATE OR LOCAL LAW REGULATING CON-
$37.50
Fie SC $1.18
STR CTI OR T PERFORMANCE OF CONSTRUCTION.
_C/39.27
PLAN CHECK FEE
lei
TO L FEE
SIGNATU F ON. RACTOR OR AUTHORIZED AGENT IDATEI
ITG^�
EN ROP VALID T/r THIS IS UR7-d-
�
B G INSP OATE `
S,GNATUREOWNER IIF OWNERBUILDERI IDATEI
NEW [ ] Effective 1 / 1 /98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 aZ
BUILDING PERMIT APPLICATION
3 SSD
ConstructionAddress: 4<91$
Legal Description:
Owner Name & Address: %e�c`�,�, �pe�V1 ce (` Tel #
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. 3
OTHER: P�,� i® '4�vaC Ynj"--� = /, /91 y.G/
Construction Type:
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
DATE:
APPLICANT:
Estimated Cost: $
(Fee Schedule on Back)
Ft x $ = $
Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ 51,'5-6
Fee Schedule on Reverse Side
Fire Surcharge
$ 4
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 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
$
STIPULATIONS:
�C/ CP
vPr7,
-ez� f -Z-t-7
4, X?-
SUBJECT
City of Fridley
29033
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
`v ------COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC
/ 5/5,r
PROTECTIVE
1 ; �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
3/19/99
JOB ADDRESS 4868 3 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3,4
2
Plymouth Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Ray Spencer 4868 3 Street NE
325-8848
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Allied Fireside 2700 N Fairview Ave, Roseville, MN 55113
(651) 633-2561
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO
20090911
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION] ALTERATION ❑ REPAIR
O MOVE ❑ REMOVE
B DESCRIBE WORK
Install a Quadra Fire #31005 Wood Burning Stove in Living Room - vented through
roof
9 CHANGE OF USE FROM TO
STIPULATIONS
Install per manufacturer's specifications. Approval
agency noted on unit.
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
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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,200
$1.10
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY O HER ST TE R LOCAL LAW REGULATING CON-
STRUCTION O THE FORMA E F ONSTRUCTION
$74.75
Fire SC $2.20
PLAN CHECK FEE
TOTAL FEE
-3 ef?
License SC $5.00
$83.05
�GN4TURE OF CON'RACTOR OR AUTMOR,ZED AGENT ,DATE,
WHEN PROPERLY ALIOATED THIS IS YOUR PERMIT
T--?-";
/OATE
S,GNATURE OF OWNER,,F OWNER BUILDER, (DATE,
BLD,N5 P
NEW [ ] Effective l/ 1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION����
ConstructionAddress:C-
Legal Description:
Owner Name & Address: Z4-ape-nce r Tel. #
Contractor://,'eel ", �e s.'�� MN LICENSE #�
Address:,)% eta, ; r r/, ` A,. /a;� 14 /y, c Tel. # &I'/ / -X33
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:
' 1vlt�'�
Construction Type: V td-)�d ���`�� Estimated Cost: $ - C
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 3- I `I 'rfi APPLICANT: zz-1S--R /l Tel. # 6,r/ -C,3-7 s�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ /- / 6)
$ S -vv
S O�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.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 [ ]