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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N°5 3 z 7 Date: Owner: r -� ,i� ` ,e�� Builder — — Address _ _ Address LO OF BUILDING No. Street o y` Lot —.__ Block ddition or Sub -Division Corner Lot ____ Inside Lot _ _ ____ Setback --! S3 yard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING r T=U Front Depth 1�eight Sq. Ft. Cu. Ft. 49 Fro n — DepthHeight Sq. Ft. CFt. Type of .Constructs _- Est. Co ; u. 2 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 e express condition that the person to whom it is granted and his agents, employees and workmen, In all work Min, 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 any of the provisions of said Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to no the Building Inspector for separate permits for these Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, IOTA Owner's Name, - AddressAddress LOCATION OF BUILDING d No. Street :J4 0.� Part of Lot ZV-d. ..� Lot 1:2 Block �� Addition or Subdivision Corner Lot Inside Lot Setbacks Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To use j . Front D­�4_epth -5 Height Sq. Ft. �[a ,;-L- Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be Completed 0 & The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DAM SIGNATURES -� 43 (A Schedule of Fee Costs can be found on the Reverse Side.) 0 r1 L.J • City of Fridley, Minn. BUILDING PERMIT Date: June 1, 1965 Owner: Maurice Weisman Builder Address 5810 _4th Street N. E. Address Bird Bros. N° 7610 '0asrIV-4-- 5245 University Ave. N. E. LOCATION OF BUILDING No. 5810 Street 4th Street N. E. Part of Lot Lot _ 2 _ Block 29 Addition or Sub.Division HYde Park Corner Lot Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Front Depth Height Sq. Ft. Type of Construction Fst. Cost _ 700*00 To be Completed Storm Damage Repair Cu. Ft. Cu. Ft. In consideration of the issuance to me of a permit to construct the buildin described above I agree to do the proposed work in accordance with the description abeVe s`et® forth and. com ce with a'll provisions of ordinances of the city of Fridley. . 4 In consideration of the payment of a fee of $10.00 , permit is hereby granted to De= Pe Bard 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, Minnesotalocation, construction, alteration, maintenance, repair and moving of buildings w thi nthe city limits permit may be revoked at any time upon violation of any of the provisions of said NOTICE: Uh permb don not cover the condrucNan, knbRafion for vArhM per&& as hadeg, =war or wafer. Be wre to no the Butldiep hupader for ape per -ha for thea hams. 3,700.00 O APPLICATION FOR BUILDING PERMIT CITY OF, FRYDE# xnaESOTA OWNER'S`NAME' %urine Weisman"' BUILDERBird Erie ADDRESS 5810 -4th Street N.N. ADDRESS 5245 Univeilsity'Ayer N.E. L0UTZON° OF BUILDING` No. Street Part of Lot LOTLOCR �, ADDITION OR SUBDIVISION 6LA Corner' -lid Inside LOT,_,; Setback_.. Side-y&rd' SEWER ELEVATibNOUI�bATIOi ' ELVATibi - Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPI'ION`OF BUILDING To be used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height'` Sq. Ft. Cu: Ft: Type of Construction— Estimated Cost z® �. To be completed The undersigned hereby makes application fora permit for the"work herein specified, Agreeing to do all work it strict accordance with the City of Fridley Ordinances and rulings of the Department of auildiats"And hereby declares -that all the facts and representations staied-in this application are true and correct. DATE SIGNATURE A0 �� (Schedule of Fee Costs can be found on the Reverse Side e a a City of Fridley Application for Plumbing and Gas Fitht 'ng Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures It, _ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... ........... . .. x $1.50 $ �O • Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ......--� x 2.00 $ New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... 6 x $1.50 Additional Fixtures x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description $ TOTAL FF3; City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this applicaticorrect. ftt� — Fridley, Minn -'? 19-(�/ Owner Kind of Building G ez,—y , /'!' --v v��v Used as To be completed about / Estimated Cost, $ Old 5Xullding Permit No �3a� Pe Signe By Business Phone No. ROUGH '% —11— Q FINAL 4z 2M Z0 Z d t90 • F • N WATER HTR. GAS ELEC. Base a 1st 2nd 3rd 4th ` Future Connection Openings New Fixture, Old Openings Connected with Sewer � Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... ........... . .. x $1.50 $ �O • Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ......--� x 2.00 $ New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... 6 x $1.50 Additional Fixtures x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description $ TOTAL FF3; City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this applicaticorrect. ftt� — Fridley, Minn -'? 19-(�/ Owner Kind of Building G ez,—y , /'!' --v v��v Used as To be completed about / Estimated Cost, $ Old 5Xullding Permit No �3a� Pe Signe By Business Phone No. ROUGH '% —11— Q FINAL 4z 2M T Application for Power Plants and Healing. Cooling, Ventilation..Refrigmation and Air Conditioning Systems and Devices Dept. of Bldgs. Phone SU. 4-747 PARTIAL RATE SCHEDULE � GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 "BTU ....................... 2.00 $ Replacement of Furnace . 0.00 $ e Repairs & Alterationsrup to $500.00 ... ............ 5.00 $ Repairs & Alterations. each add. $500.00 ............... 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam....... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $_x = 1 L Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ _ ALTERATIONS & REPAIRS TOTAL FEE ROUGH f FINAL— (REMARKS-OVER) IN L City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Kind of _ Used as To be completed about Estimated Cost, $ Old Ne . uilding Permit No. Fridley, Minn - Owner inn2 Permit No. /3— DESCRIPTION 3 DESCRIPTION OF WORK HEATING or POWERPZ.ANTS- Ste Hot Water" arm Air—No 06 Trade NSize No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Loads. Z� e2 ".&A — Kind of Fuel BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS-OVER) Sign N a4 Pei �V . Bye oz zM �.s9 Business Phone No �'-� HEAT LOSS/ CAL�CJULATION DEPARTMENT OF BUILDINGS FRIDLEV, MINN. Weatherstrips A.S.H.V.E. Guide Reference 19_ 0 ® -0 Construction No. Coef. Btu Insulation Windows Doors Yes Yes—No Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Infiltration Coef.1 Btu . Room ( Length / Widt Height P 6 FI.� Dom Length Width Height Windows a Doors—Crackage and Atea � Windows andoors--Crackage and Area Width Height No. of Lineal ft. Ares No. of Dane of pane lights of creak eq. ft Width Height No. of Lineal f . Area No. of Dane of Dane Ilghts of crack eq. ft. 1 otal btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.0 A Room l Length A, Width / l° Height -.P Windo s and Doors--Crackage and Area Width Height Noe of pane of pane No. of Lineal ft. Area Ilghts of crack eq. ft. 0 ® -0 Coef. Btu i Btu Coef. Btu Infiltration Coef.1 Btu . Infiltration Glass Exp. wall 3 Glass � Net exp. wall 6 Exp. wall 47o Int. wall Ceiling L 2 Net exp. wall Ceiling a Int. wall Floor Ceiling 1 otal btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.0 A Room l Length A, Width / l° Height -.P Windo s and Doors--Crackage and Area Width Height Noe of pane of pane No. of Lineal ft. Area Ilghts of crack eq. ft. Coef. Btu i Btu Infiltration C, Coef.1 Btu . Infiltration 1e 3 Glass Net exp. wall Q 6 Exp. wall ^® Ceiling L 2 Net exp. wall Floor a Int. wall Ceiling Floor Wi dows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Coef.1 Btu Infiltration C, Glass Net exp. wall Exp. wall VP 3 Ceiling Net exp. wall Q , Int. wall Ceiling L 2 Floor Tbtal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 4 3 e II I% Coef. Btu Infiltration Glass Exp. wall Net exp. wall ®` 4 /@ wea Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Jv— l Room I Length Width .7 Height r i 'dows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall 3 Ceiling , Floor Total Btu. Required sq. ft. E.D.R. or sq. iris. W.A. Leader area F1.1 Rnam I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Coef. Btu Infiltration 61 Glass Exp. wall Net exp. walltEZ2 Int. wall 3 Ceiling , Floor -- Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area —j 31) 6 Application for Power Plants and: Heating. Cooling. Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU, 4-7470 GRAVITY WARM AIR: RATE TOTAL, V Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ........................ 2.00 $ _ Replacement of Furnace ............................. .0.00 $ Repairs & Alterations—up to $500.00 ... ............ 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam....... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal, per hour 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTL) ................... a O ..... 5.00 $ S. o3=/D! GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ f SB Additional Fixtures .................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH — A FINAL $ See Fee Schedule $ TOTAL FEE $/�• �D City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn 19 4z Owner Kind of Building Used as To be completed about Estimated Cost, $ _'�Uo Old—New. Building Permit No. _ Permit No. �� O DESCRIPTION OF WORK HEATING or PO PLANTS --Ste of Wa , Warm Air—No�_ i Trade Nam Size No Capacity,A.A� O� ®SB A' Sq. Ft. E.D.R BTU H.P. Total Connected Load L/ O Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. 4 (REMARKS—OVER) Signe By 42 2M 7_s9 Business Phone No � City of Fridley AppGcafl®e for PhmMng and On Ibing Peru Dept. of Bldgs. Phone SM -34M 5915.51 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location 5812 N E 4 St. PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .... x $2.00 $ 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) .... x $3.00 $ New Ground Run Old Bldg. x $3.25 $ Electric water Heater z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL lot 3 Fixtures ...... ...... ........... x $2.00 ;- Additional Fixtures . x $ .75 $ Gas Range to 199,000 BTU .............. —J x $5.00 REPAIRS It ALTERATIONS—Refer to Code Description ..............................................$ TOTAL FFA_ City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City 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, Minn 21 Jul 69 19_ Owner Wa R Kostick Kind of Building fr Used as res To be completed about 25 Jul Estimated Cost, $ 5 *vW Old—New. Building Permit No Fermi ®. Si t By Business Phone No ROUGH I FINAL (� J 1 il 9 i t N WATER YITR. GAS ELEC. 21 � Base cc Iln r let _ 2nd – 4ih _ m Future ConConnected with e Now Fixture, Old Openings I C] Cesspoolsewer PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .... x $2.00 $ 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) .... x $3.00 $ New Ground Run Old Bldg. x $3.25 $ Electric water Heater z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL lot 3 Fixtures ...... ...... ........... x $2.00 ;- Additional Fixtures . x $ .75 $ Gas Range to 199,000 BTU .............. —J x $5.00 REPAIRS It ALTERATIONS—Refer to Code Description ..............................................$ TOTAL FFA_ City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City 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, Minn 21 Jul 69 19_ Owner Wa R Kostick Kind of Building fr Used as res To be completed about 25 Jul Estimated Cost, $ 5 *vW Old—New. Building Permit No Fermi ®. Si t By Business Phone No ROUGH I FINAL (� J CITY OF FRIDLEY PERM No.: 2004-00340 6431 UNIVERSITY AVENUE NE - FRIDLEY, MN 55432 DATE ISSUED: 03/16/2004 F631 572-3604 FAX: (763)571-1287 ADDRESS : 5812 4TH ST NE PIN : 233024240114 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 1,359.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SOFFIT VENTILATION TO MEET CHAPTER 15, 2000 INTERNATIONAL BUILDING CODE. STATE LICENSED CONTRACTOR 1 APPLICANT CUSTOM REMODELERS INC (1748) 474 APOLLO DR LINO LAKES, MN 55014 (651)784-2646 OWNER HAIGHT JOHN E & FRIEDERS E M 280 BRADFORD ST PLATTEVILLE, WI 53818 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Bldg Inspj BUILDING PERMIT FEE 50.95 FIRE SURCHARGE 1.36 STATE SURCHARGE, VALUE 0.68 LICENSE SURCHARGE 5.00 TOTAL 57.99 PAID WITH CHECK # 44964 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ ] AD+DN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: Contractor: lei� Address: 4-74 6 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DEQ- & 1/1/99 a Tel. # MN LICENSE # Tel. # qb Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground . Sq. Ft. Construction Type. Estimated Cost: $� 3 59. D C) (Fee Schedul a on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ff x $ _ $ DATE: Tel. #6151 -79+ J 6q b CITY USE ONLY Permit Fee $ 6o, q6-*- Fee Schedule on Reverse Side Fire Surcharge $ 6 .001 of Permit Valuation (1/10th%) State Surcharge $ $.501$1,.000 'Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ 06 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Vontrol $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement -Necessary [ ] Not Necessary [ ] TOTAL $ .. ��... !. �- �z�6� STIPULATIONS: Number PLUMBING Pe ' RESIDENTIAL APPLICATION City of Fridley NOTE: IF PROPERTY IS NOT OWNSPJOCCUPIM A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE L-5 _0 (o YOUR E-MAIL ADDRESS SITE ADDRESSa7e&�7'al THE APPLICANT IS: (CIRCLE OTIE) OWNER COMYRACTOR NAME `• 10 HIV N,,9 -t6147- PROPERTY GMERI ADDRESS cid SO 4�,C/4CJ,FQ'�2.d i TENANT CITY 771E yrLL-L aIP.�3 PHONES NAME JE OWN �` �'gG LICENSE B ADDRESS��ra -�. r� CONTRACTOR CIIY /nr�/ ^� L/S STATE %�'?�✓ zip 5f3�fQ� PNONE 9�tirvZ - 7G2r` SFu 8 u PERMIT TYPE X SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK O NEW REPLACEMENT DETAILED DESCRIPTION OF WORK /P�L0}C" 4(0 �� 9476?—p- FEES ARE BASED ON S10.00 PER FDCTURE, EXCEPT WMME NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) ._BATH SINKILAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Nsed City License) SWIMMING POOL WATER SOFTENER ($35) CLOTHES WASHER —KITCHEN SINK WATER CLOSET BACKFLOW PREY, ($75) DISHWASHER LAUNDRY TRAY WATER HTR ($35) FOR IRRIGATION WATFR METER OTHER Permit Fee $ J , MINIMUM: $15.00 or 3% of cost of the improvement whichever is Plan Review $ greater on work lose than $300 Surcharge $ TOTAL DUE $ 5 Make checks payable to: City of Fridley APPLICATION FOR A PERMIT - NOT VALID UNTIL PROCERSED 1 hereby apply for a plumbing permit and l admowledge that the Infommilon agave is complete and accurate; that the work will be in conformance with the ordinances and lodes of the City of Fridley and with the lArmmta Construcdon Codes; that I undersb M this is not a permit but only an application for a permit and work is not to start without a permit that the work will be In accordance with the approved plan in the rase of all work which requires review and approval of plans. p NAME OF APPLICANT /i9�4/Q. Z t u 4Cl /`7i'rX72, _ DAk-_(�- a �.: - I X or SIGNATURE OF APPLICANT dt 07 ►- /A 8431 UNIVER17Y AVENUE NE, FRIDLEY, MN 65432 (T63) $72-3604