PRE 2010 DOCS•
E
City of Fridley, Minn.
BUILDING PERMIT N® 6826
Date:
owner: Builder _. f
Address Address —
.
LOCATION OF BUILDING
No. Street 4�--�—____ Pf Lo
Lot _ _ _ __ Block Addition or Su onC,Ci _�
Corner Lot Inside Lot __ �� Setbac —_ Sideyard
Sewer Elevation _ _ F ZnZion Elevation
DESCRIPTION OF BUILDING
T
Front Depth Height ZAQ Sq. Cu. Ft.S=
Front Depth— Height Sq. Ft. Cu. Ft.
Type of Construction a�� Est.C�st/_2 Yjle 4,0�—__ 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
tnparon of the city of Fridley. /) _ 1 _ , o
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, maintenan repair and moving of buildings
within the city limits and this permit may be revoked at any time upon ola on of any of the provisions of said
ordinances. ' 5 ul
Building Inspector
Nonce
M permit does not corer the Gond. cdoa, Instdia w for wirlag, plumbing, gas heating, sower or water. Be ams to see
the Building Inspector for separate permits for these hens.
V . s
APPLICATION FOR BUTLnING PERMIT
CITY OF FRIDLEY, IaVNESOTA
O'"PRU0' S NAME -talnc5 _Z Fr d k BUILDER -e--
ADDUSS 6r 7 (nn .- .yid S'¢ ���� ADDRESS it-S"o 001"o X og T,7` � t
r
LOCATION OF BV"LDING
No. Street Part of Lot
Low Block Addition or Subdivision_ RI tz
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOU1'dDATION ELEVATION
Applicant attach to this form Two Certificates.of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
t7�:
��-*
.Old -e� 7t -d e Front Depthc;l.�2C Height,
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of ConstructionEstimated Cost '`/3 %�oG
To be Completed 90 c�
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 //&tl(-
(Schedule of Fee Costs can be found on the Reverse Side).
r
S&O - s 3?/
LOT IVALS -Tfg* a 6, k g/�7jgjW pin -U x a hr
BLOCK ADDPMS 4 71- V.A LUAT
ADD. -
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................... ......
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•
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City of Fridley, iron N° 7679
BUILDING PERMIT
Date: Jane 2, 1965
Owner: James Frank Builder _ P. ILS. _ C1A3m Service
Address 6760 44th. Street N. E. Address 6305 Bryant Ave. So.
LOCATION OF BUILDING
No. 676Q Street 1+th. Street N. E. Part of Lot
Lot _ Block Addition or Sub -Division Rice Creek Ter -race 9 Plat 3
Corner Lot _ Inside Lot Setback Sideyard
Sewer Elevation
To be Used as:
Type of Construction
Front
Foundation Elevation
DESCRIPTION OF BUILDING
Depth Height Sq. Ft.
Front Depth Height Sq. Ft.
Est. Cost.s to _ To be Completed
Storm Damage Repair
Cu. Ft.
Cu. Ft.
In consideration of the issuance to me of a permit to construct the building described above I agree to do
theproposed work in accordance with the description forth and in compliance with ;h Rrovisions of
ordinances of the city of Fridley.
'�--—
In consideration of the payment of a fee of 0.00 , permit is hereby granted to P. D. Q. CM ajM
saindae to construct the building or addition as described above. This permit is granted upon
the express condii3on that the person to whom it is granted and his agents, employees and workmen, in all work.
da a in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnceota g location, cronatruction, alteration, maintenance, repair and moving of buildings
within the city ]imits� permit may be revoked at aqq time upon violation of any of the provisions of said
ordinances.
Allen Jensen Building Inspector
NOTICE
We pormh don not cover the construetion, heron for whing, plumbing, gn hsathm sewer er water. Be n to no
tis Budding InVeder for nparate pwmib for then (teum
APPLICATION FOR B • ING PERMIT
CITY OF FRIDLEYe IENNESOTA
OWNER'S NAME BUILDER 1-70,
ADDRESS ADD99SS ®�
,4
LOCATION OF BDING
No. Stteet Part, of Lot
Lot .21 Block Addit.ioa+ or Subdivision P C /7t,
Corner Lot Inside Lot __$etb'ack Side -Yard
SEWER ELEVATION
FOUNDATION ELEVATION
Applicant attach to thin form, Two Certificates of. Survey of Lot and proposed build-
ing location dtAwn on these Cettificates.
To be used ds:
DESCRIPTION OF BUILDING
front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sze,. Ft. -Cu. Ft.
Type of Construction e I., Estimated Cost ZA?-T, /p
_. fio-.be Completed
The undersigned hereby makes application for a 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 Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
JScedule of Fee Costs can be found on the Reverse Side).
■ Statement
A A Q. Contractors
Box 6481
Richfield, Minn. 55423
Telephone: 869-0057
FILE NO,
196
TO 7
77,_5 7-.i e, C,
&V C1 nd0w
1°e-P0?o '�
S
o In
fii
0-1
SUBJECT
PER
City of Fridley
13092
AT THE TOP OF THE TWINS
PERMIT
r
BUILDING
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
�
i /"'1,� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
--•_�
L ' , 612-560-3450
910-F15
17-16-75
JOB ADDRESS
6760 — 4TH STREET N.E. FRIDLEY MINNESOTA
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2
RICE CREEK TERRACE PLAT 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
JOHN BAUNE 760 — 4TH STREET N E FRIDLEY, Mlk=SOTA
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION "ffx REPAIR
❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
9 CHANGE OF USE FROM TO
STIPULATIONS
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,
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$6.60
e
PLAN CHECK FEE
TOTAL FEE
lA
SIGNAT EOFCON14, CTORORAUTHORI ENT (DATE)
(/
/WHEN PROPERLY yALIDATED THIS IS YOUR PERMIT
/C/d
BLDG )NSP
LY 16, 1975
DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
0-1
• ' i2ATI0N,
-APPLICATION FOR RESI'DENTIAL., ALTI
OR ADDITION•BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NMIE : VZ&L—_�_BUILDER,
ADDRESS': — � ADDRESS
ADDRES• —
NO:. STREET:
TAT: BLOCK:d2- ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDE -YARD:
.Applicant attach to this fora, lVo Certificates. 'Nf Survey . of Lot and .proposed
building location drawn. on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
SGC '
Front: Depth: Height-
-
Square Feet: Cubic.Feet:
• Front:' Depth:. Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: $-
To- Be Completed:
The undersigned hereby makes application for 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.
l� % SIGNATURE •
• DATE:-
• (See Reverse Side For Additional Information.)*
to � .
SUBJECT
PERMIT N
City of Fridley=71j
AT THE TOP OF THE TWINS
BUILDING PERMIT
rp
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L J \ 612-571-3450
910-F15
6/1/83
JOB ADDRESS 6760 - 4th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
2
2
Rice Creek Terrace Plat 3 SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
aNWV Carol Baune 6760 - 4th Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
W-All Service Inc. 3851 Central Avenue N.E. 788-9411
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
8 DESCRIBE WORK
Replace windows
9 CHANGE OF USE FROM TO
STIPULATIONS
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
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
$1,000
$.50
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-
$17.50
TR CTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$18.00
SIGPATOEOFC TRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPE VALIDATED THIS IS/YOUR PERMIT
BLDG INSP DATE
SIGNATURE OF OWNER(IF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
Effective Aug. 1, 1981
APPLICATION FOR RESIDENTIAL BUILDING PER14ITS
(New, Alterations, Additions, or Repairs)
OW14ER: Gf_120 Z 131ttiE •BUILDER: .84 `�L�
ADDRESS: 60 �7h � �f= P ADDRESS: L6ti-t'�"9L
TEL 90:
TEL NO: -M l
Construction Location
STREET NO: X,4( STREET: �n`I �7 ' kll
LOT: BLOCK: ADDITION: c e' L
Corner Lot: Inside Lot: Setback.: Sideyards:
Ap,plicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
Front:
DESCRIPTION OF CONSTRUCTION
Depth: Height:
Square Feet: Cubic Feet:
Front:
Depth: Height:
Square Feet: Cubic Feet:
vd�
Type of Construction-_ - a _ i Estimated Cost: $ /04940. 00
4b Be Oornpleted: �"� L (n
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE F.EVFRSE SIDE OF SHEET
ZSie undersigned hereby makes application for a permit for the %:,ork herein specified,
agreeing to do.all work in strict accordance with the City of Fridley Ordinances and
rulings of the Delkzrtment of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: /0 / 4 / e SICNATUIE:
Stipulations:
Pfi,,,.A n. V
1Cpsdam
i
du
�
SUBJECT
NO.
City of Fridley
11472
AT THE TOP OF THE TWINS
B U I L D I N G P E R
M I T
r
RECEIP NO.
COMMUNITY DEVELOPMENT DIV.
1 v PROTECTIVE INSPECTION SEC.
r 1 �
CITY HALL FRIDLEY 55432
".j
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/5/97
JOB ADDRESS 6760 4 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2
Rice Creek Terrace Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Robert/Brenda Bawne 6760 4 Street NE
572-0508
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.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (18 Sq) 1041 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be 2nd layer but not 3rd.
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
$1,127
$.56
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-
$40.25
Fire sc $1.13
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$41.94
OFCOONTRAC``\TTOORROORRAUTHORIZED AGENT (DATEI
`x/
'hA
l� ` �y'INNER,
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
ATSIGNATURE
S�GNUREOF IF OWNER BUILDER) IDATEI
BLDG INSPP
��ATE
NEW [ )
ADDN [ J CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress :
Legal Description:
�q)exA .rtrt
Effective 1/l/97
Owner Name & Address "h�l-�-- fzfl ,`IT)LA� Tel. # 5?9- C60 �
Contractor: 4MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Lien► Width Hgt/Ground Sq. Ft.
OTHER: Y�4)aC /6 S� _
Construction Type: s� I r�'o P Estimated Cost:
(Fee Schedule on Back)
Driveway Curb Cut .Width Needed: Ft. + 6 Ft = Ft x $ _ $ °
DATE: �J ' 9 °% APPLICANT:" �i�'tCYNCcu; Tel.
CITY USE ONLY
Permit Fee $ 416 . S Fee Schedule on Reverse Side
Fire Surcharge $ /. /_j .001 of Permit Valuation (inoth%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $950 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
fewer Main Charge $ Agreement Necessary [ ] Not Necessary j ]
TOTAL $
'11PULATIOiNS:
SUBJECT
City of Fridley
26946
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
i V _
~ PROTECTIVE INSPECTION SEC.
1 ,
NUMBER
DATE
PAGE OF
APPROVED BY
1 S ..---I CITY HALL FRIDLEY 55432
. I.J 612-571-3450
910-F15 TREv
7/31/98
JOB ADDRESS
6760 4 St NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2
Rice Creek Terrace Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Bob Baune 6760 4 St NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Owner
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Resident al
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION IR REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof 8 Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be 2nd layer but not 3rd.
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
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
500
.50
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
$.50
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$21.00
FlAe SC
0 ` / � ��j %%
PLAN CHECK FEE
TOT EE
22.00
rA E'
SIG UR OF d_0NTRACT6 22
OR AUTN . AGENT IDATEI
N OPE ALIDAT HIS I$ UR R
INSP
r �
GATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 14/4'740 1114
Legal Description:
Owner Name &Address:S44 v 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 BIPROVEM ENT
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: 1 n Estimated Cost: $ �® (7)
(Fee schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: Z-3 APPLICANT:
K-/, �� Tel. #
CITY USE ONLY
pct
Permit Fee
$ i
Fee Schedule on Reverse Side
Fire Surcharge
$ a 5-0
.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 [ J
:2
TOTAL
$
STIPULATIONS:
r .of