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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. No Date.............. ..`................... 0 Owner ......... ...47 ...... i� Address /40 �.. ... !. .. �'...... . 2967 Builder .. ..... Address/• ? /.'..� ....................... . /9LOCATION OF BUILDING ,(..DNo. ./....... Street I�.GJ .. � �'��u.............. Part of Lot ....................... ems, _. / Lot ................ Block ... .......... Addition or Sub -Division .. ...... ......✓.��1�?�: C Corner Lot ............ Inside Lot ............ Setback ............ Sideyard .......................... DESCRIPTION OF BUILDING To be Used as: 1 lQla/ .................... Front ........ Depth ........ Height ......... Sq. Ft.. ! , `? . Ft........ . .................... Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft......... Type of Construction .............. Est. Coe. .� To be Completed ................... r f. 1 yv o JOY 4 IV X /G In cons di eration of the issuance e 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 ✓4 ordinances of the village 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 grant pon the express condition that the person to whom it is gran ted and his agents, employees and workmen, in 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 with- in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. .� �.t4Z� .. Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. � ® v ®tA !` 0 c� _I M � � Ob • • 0 City of Fridley, Minn. BUILDING PERMIT N® 6650 Date: Owner: wilder Address Address 1 N F DING No. Street / L �� P o Lot Lot .- _ _ :F- --Block z Addition or Sub -Division RN Corner Lot _ Inside Lot _ _ Setback .0 ---- Sideyard f Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING , A -5; W41, %41)056 i 4Front le— Dept4_ Wr of ..�JAWA Est Height1r /� Sq. Ft. ylj�10 Cu. FtlW ofHeight Sq. Ft Cu. Ft obe Completed i 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 f and in�c fiance with all provisions of ordinances oP the city of Fridley. // In consideration of the payment of a fee of It G �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, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon vio of any of the provisions of said ordinances. /"'� _ NOTICE: We permb don net cover the cemtruction, Installation for whing, plumbing, gas heating, sewer or water. B• sure to see the BwMiog hwpedor for Separate peradls for these Nene. Is 0431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 r] OBSTRUCTIONI: Lot Block Addition eq Property Omier -.,Lddress XW1 RE -CORD OF MMUNUMTIONS: 2. 3. 4. S. 6. 7. v SUBJECT PERM City of Fridley o 18629 AT THE TOP OF THE TWINS BUILDING PERMIT r IPT N ' L-------- COMMUNITY DEVELOPMENT DIV. r I PROTECTIVE INSPECTION SEC. /---1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY j 612-571-3450 910-F15 9/5/86 JOB ADDRESS 101 ., 49th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 1 Carlson's Summit Manor South. Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Mangen 101 - 49th Avenue N.E. 572--8733 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 ❑ ADDITION §7 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install Preway Super Energy Miser o--clearance fireplace 9 CHANGE OF USE FROM TO .ITIPULATIONS Provide fire alarm in hallway leading to all bedrooms. SEPARATE PERMITS REQURED FOR WIRING, HEATING, PLUM J.NG A.ND SjCt4S,, 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 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 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 $5,00.0 $2.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE ,PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $50.50 PLAN CHECK FEE TOTAL FEE $53.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WIEN PROPERLY ALI DATED THIS IS YOUR PERMIT z6(e f fiATE`_ NATURE OF O#WR OF 6WF4,rR BUI RI IDA EI v NEW [ ] City of Fridley Effective 4/1/8(° ADDN. [ ] R-1 AND R-2 1 ALTER. [ ] Building Permit Application Construction Address: Id 1 41 4_L-_ AIJG C' Legal Description: '` 1 Owner Npme s Address: ��°`�` Tel. ! 6777Z-873 Contractor: 1�-�`►��� Tel. # Address: 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 .r Width Hgt/Ground — Sq. Ft. OTHER: �i GC-���.M�3 //zep eE WAJ00�S a 5l �� r Corner Lot [P4 Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: v'Aw5 , S/On�C7 Estimated Cost: $ 4 6�'O Approx. Completion Date: f2 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: ------� $ $ See Back Page for Explanation DATE: --f� / APPLICANT: �K J. MA Tel. o 6 72- - X733 Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer blain Charge TOTAL STIPULATIONS: CITY USE ONLY $ 6z),U)Fee Schedule on Reverse Side $ 25% of Building Permit Fee $. �� $.50/$1,000 Valuation $ $475 per SAC Unit $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ Uo SUBJECT P City of Fridley _ 22374 AT THE TOP OF THE TWINS BUILDING PERMIT i � RECEIPT NO. COMMUNITY DEVELOPMENT DIV. _ r � � PROTECTIVE INSPECTION SEC. ' NUMBER REV. GATE PAGE OF APPROVED By :1L i 1 � CITY HALL FRIDLEY 55432 "'" 612-571-3450 910-F15 3/29/94 JOB ADDRESS 101 - 49th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR, 8 1 Carlson's SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Paulus 101 - 4th Ave579-1934 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 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Chane Rorch r ' x 121 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. Provide smoke detectors adjacent to all sleeping areas and in basement as per UBC 1210. WARNING Before digging call for all utility locations 454-0002 REQUIRED BY LAIN TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 60 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,200 . PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Fire SC $1.20 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $29.00 PLAN CHECK FEE TOTAL FEE 30.80 � SIGNATURE OFCONTAACORAUTHORIZEDAGENT (DATES yy N p OPER Y VALIDATED THIS IS YOUR PERMIT U ll�C:� BLDG INSP SATE SIGNATURE OF OWNER 0F OWNER BUILDERS IDATES NEW [ ] Effective 1/1/94 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1. AND R-2 Building Permit'Application Construction Address: /O/ Legal Description: Owner Name & Address: G qgg j A. P/+LAW s &1 `/ 5 fA Aur A-)• F- Tel. # Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: MN LICENSE # Attach to this -application, -a Certificate of Survey of the lot, with the 'proposed' -construction drawn on if to' scale. DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length /Lo 4. Tel. # 5 7d-3913 Sq. Ft. Sq. Ft. Corner Lot C4 Inside Lot [ ] Ft. Yd Setback Type of construction: VecK -;- 'No?, Approx. Completion Date: 'Side Yard Setbacks v V Estimated Cost: $/,�- ® o (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 3/a 5 9 APPLICANT: piz /4 . ' jP)q" L" 5 Tel. # 5 ?d-- 313 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY $ °7 ®� Fee Schedule on Reverse Side 41( $ I., ) .,) .001 of Permit Valuation (1 / 10th %) $ $.50/$1,000 Valuation $ $800 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 [ ] TOTAL $ STIPULATIONS:WV , Yr. 1 .. r,• ►- I: i Tical c� Kmer 4.AA OCO,(ZXO I' . WARNI +I NG r{ " Before digging call for r " �''1. 411 utility locations 454-0002 e y, q(REQUIRED BY LAW ?------------- xG,, r tower t��7 O-er� POA ,C A CA( cOm � K pc-rc�, ✓-CIC 4 i viz' �a( Ply leek Tce �waJ�r �wel� 9 � v C D Z N M m .m 1� m SCALE- 1"-50' PILOT' AVENUE M 0 D Z 0 0 49th. AVENUE j� N.E. . 1 Sc#f-c r - I :�eraty ec:'•i^; that ti- nb..e la a sarroy-bf :xtv Mc (1) thror.Ch i+.tern Biocr. •Jua (1). �G :L:41':. :+�Y PrS;O;i ,;Cu .7.1 .%T 1iIU:. knnka Counry, i�innenota. sho:jiaj; the. locution of the houses on aurid lots- ha surveyed by me this 25th day of Naarob 195,4 A. D. i iflnhAD to istratios CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Effective On March 1, 1996 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES� JOB ADDRESS /DI - `�� /10 4"-') X), Residential Rate TOTAL Furnace Shell and Duct Work, Burner — ®p Also Replacement Furnace $ 30.00 ®`— (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $10.00 $ Gas Range Gas Dryer *Air Conditioning — All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work $10.00 $ $10.00 $ $25.00 $0�19� State Surcharge TOTAL FEE $ .50 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. —� ,1996 BUILDING USED AS ESTIMATED COST 2P PERMIT NO. d' Qg§CRIPTION OF FURNACE AND OR BURNER No. of Heating UUn�its" I Circle One (Steam) �Water)(Warm Air) Trade Name �! ./wo- � Sizeq-5— BTU SBTU )S 0Z)t-� HP EDR Fuel V° Total Connected Load Burner Trade Name Size No. iylp BTU �_2 .. bbO HP EDR HEATING COMPANY _J2&hJAKV-, Lkz� Sign4f.'4,07�11 , .? P' Approved ByRough—In Date Final Date FILL OUT BACK SIDE R STACK VERIFICATION ON �Q l REPLACEMENT FURNACE �J� CEDINEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. 3. 4. 5. WA E:3 Is fr, 7 from rust or deterioration Has i foreign objects lodged within Is se4eely supported Meets all current Code requirements for size and total BTU's connected Has total heating BTU's of All other BTU's TOTAL BTU's Has a liner been provided for water heater Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes ()No() Yes ()No() Yes ( ) No ( ) Yes ( ) No ( ) Yes ()No() Yes ( ) No ( ) sue�Ecr PE City of Fridley 2667 7 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �`�i=7 �� , �f�1�/ NUMBER REV DATE PAGE OF APPROVED BY `I i ;.� CITY HALL FRIDLEY 55432 --_•� L 612-571-3450 910-F15 17/17/98 JOB ADDRESS 101 49th Av NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 1 Carlson's Summit Manor South Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Paulus 572-3934 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Rainguard Const. 12008 Pennsylvania Ave N Champlin MN 55316 421-8897 6061 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 X1 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof garage (5 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATION S Underlayment must comply with State Building Code. 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 1 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 SPEC IED HER IN OR NOT. THE GRANTING OF A PERMIT $417 $.50 DOES NOT PRESU T GIV UTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF THE S TE OR LOCAL LAW REGULATING CON- Fire SC $.42 STRUCTION OR P MA9fE OF CONSTRUCTION. $21.00 PLAN CHECK FEE TOT FEE 1 License -90$5.00 .92 G TURE FCO ' OR AUTHORIZED AGENT /DATE)- N OPE F ALID T THIS IS_Y.QVR PERMI BLD INSP 6 ��ATE SIGNATURE OF OWNER IIF 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: Q/ Wvll�yl–� Legal Description: Owner Name & Address: �� 9 Tel. Contractor: s y �� , , �,�� r �� �,.Lf �} 11–t'>�?S i 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 _ GARAGE AREA: Length Width Height — DECK AREA: Le Vdth Grounc OTHER: `� _ (�,2 �1(•� S Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: P Estimated Cost: $– (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. STIPULATIONS: -- CITY USE ONLY Permit Fee $ 6 Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ S-6 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ LSC; $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: -- CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 N'AX: (763) 571-1287 ADDRESS 101 49TH AVE NE PIN 263024230008 LEGAL DESC CARLSONS SUMMIT MAN SO ADD LOT 8 BLOCK 1 PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 2,315.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE & GARAGE (20 SQ) TEAR -OFF PERMITO.: 2004-00423 DATE ISSUED: 04/02/2004 APPLICANT BUILDING PERMIT FEE 83.25 HENDERSON, JON FIRE SURCHARGE 2.32 101 49TH AVE NE STATE SURCHARGE, VALUE 1.16 FRIDLEY, MN 55421 TOTAL 86.73 PAID WITH CHECK # 2656 OWNER HENDERSON, JON 10149TH AVE NE FRIDLEY, MN 55421 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 atter 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 wort 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. ADDlica&---,� I Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. P16gy NEW [ J CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION qa Construction Address: S n l zy fh A VE NE Legal Description: Owner Name & Add r -3-no H e J e ►iso yj Tel. # W:3 9 37 5 - Contractor Contractor. e a,U�� MN LICENSE # H -S -36-`13S- 967-290 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: Leng Wid/gt/Gr undue^ Sq. Ft. OTHER: /� �f5� �j � �� Construction Type: Ong Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: �' APPLICANT: 3c o Hevkl:5®n Tel. # / 6 -;LS '7 1 —Iff 375 Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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: