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PRE 2010 DOCS• #ty of Fridley, Mian.. BUILDING PERMIT ii Owner: 6-71 An I Zh der .r •� • i N® .6.615�U�'65 //sL F BU 1 G No. Street P Lot .._ Block � Addition or Su -on Corner Lot _ Inside Lot O tback S. Sewer Elevation _ Fo dation Elevation DESCRIPTION OF BUILDING To U Front Depth Height Sq. Ft. cu. Ft. P-9-0 Front— Depth Height- _ Sq. Ft. — cu. Ft. Type of Construction Est. _ r�_ 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 compliance 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 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, and moving of buildings within the city limits and this permit may be revoked at any pen ola n of any of the provisions of said ordinances. ,►ll 018 • NOTICE~ 11ds pomdt does not corer the conatruclion, hntallation for wtrhte, phnnbing, gas heafing, sewer or wafer. Be acro to see the BuNing lir for separate permhs for these items. Application for Power Plants and Heating. Cooling, Ventilation. ReFrigerallon andUl Air Conditioning Systems and Devices 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 ............................. 5.00 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 BTU) ....................... 5.00 $ \!�-' ®n 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 �b ROUGH FINAL Dept. of Bldgs. Phone SM -3450 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 �-R-� 070 y iglo� Owner Kind of Building. Used as To be completed about Estimated Cost, $ y- 0 U Old New. Building Permit No. Permit No. �nn b DESCRIPTION OF WORK HEATING or POWER PLANTS—S,�tte��azaj, Hot Water, Warm Air—No Trade Name �� tll/ O'er'./ AaCm,&/ Size No_.—OIZ040 Capacity �2QQ 0 © d Sq.. Ft. E.D.R BTU H.P. Total Connected Load ±//� (9Q O Kind of Fue f BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) _a. • . By • • a Business City of Fridley Application for Plug and Gas Fitting Pemb Dept. of Bldgs. Phone SW -3430 DESCRIPTION OF WORK —-��-�c.c� Number. Kind and Location of Fixtures Location 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.... o 0 ........ _ L_ : mos O GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional FIxtures .................. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description .......................... , ..................$ TOTAL FEE $ (SURCHARGE $ .50)-`�� 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 Owner Kind of Building Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. Permit No. Im�? " Signed�� (J ROUGH y� By Business Phone No - qo e) 'meq 93 i• • WATER "". 7G.SELEC. Base 1st 2nd 3rd 4th -Futuro CoE nings * New Fixture, Old Openings Connected with Sewn ❑ Cesspool 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.... o 0 ........ _ L_ : mos O GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional FIxtures .................. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description .......................... , ..................$ TOTAL FEE $ (SURCHARGE $ .50)-`�� 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 Owner Kind of Building Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. Permit No. Im�? " Signed�� (J ROUGH y� By Business Phone No - qo e) 'meq 93 City of Fridley r AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PERMIT ND—_ 1 1 � F __-__ COMMUNITY DEVELOPMENT DIV. fr r 1 PROTECTIVE INSPECTION SEC.�'1(`'—�'(r� 1 i 1"'� CITY HALL FRIDLEY 55432 It----A,� j 612-571-3450 NUMBER 910-F15 REV DATE 4/26/93 PAGE OF APPROVED BY JOB ADDRESS 430 57th Place NE 1 LEGALLOT DESCR. NO. 6-8 BLOCK 5 TRACT OR ADDITION SEE ATTACHED City View Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Marilyn Young 430 -- 57th Place NE 574-9509 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 ❑ ADDITION Ek ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install interior doorway 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $550Q $a50 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $15,00 $,50 PLAN CHECK FEE TOTALFEE $16.00 SIGN�A/T��•U/R�EOF`CONTRACTOR OR AUT ORIZEDAGENT IO/AfTEI 21 WHEN PRO RLY. V LID ED THIS IS YOUR PERMIT BLDG INS _ DATE S,,NATURF OF O E FF OWN BUIL DERI IDATEI J NEW [ l ADDN [ ] ALTER [ ] Construction Address: Legal Description: _ Owner Name & Add Contractor: Address: Effective 1/1/93 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application f. Tel. #57 MN LICENSE # 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. DECD AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $. DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ . SD .001 of Permit Valuation (1/10th%a) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ j TOTAL STIPULATIONS: sueaEcr R218813 City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. ______ COMMUNITY DEVELOPMENT DIV. v I PROTECTIVE INSPECTION SEC. 1770 r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �""� �'� 612-571-3450 910 -Ft 5 6/1/93 JOB ADDRESS 430 57th. Place NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6-8 5 City View SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Marilyn Young 430 57th Place NE 574-9509 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 jl ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 10txl7t and 61 x 1V Deck 9 CHANGE OF USE FROM TO STIPULATIONS See nQta,tions on flan, :5.4-lez �- WARNING Before digging call for all utility locations 4540002 REQUIRED BY 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 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 $1' 8.78 $ 24 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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- $43, QG. Fire SC $1,88 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. . PLAN CHECK FEE TOTALFEE 45.82 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI ' WHE THIS IS YOUR PERMIT WLLIDATED BLDG INS4ATE SGNATURE OF OWN OF OWNE ILDERI IDATEI NEW [ ] ADDN [ ] ALTER [ ] Construction Address: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Owner Name & Address: Contractor: Address: Effective 1/1/93 =t+ -177o 3,3 Tel. MN LICENSE # 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. Width Hgt/Ground/ Sq. Ft. DECK AREA: Len4 OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: -- ted Cost: $ . Approx. Completion Date:`' �"�(C dton Iack). ® 6 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ /rte 71X = 1,f-397 9� DATE: - - APPLICANT:, Tel. # Permit Fee $ J,00 Fee Schedule on Reverse Side Fire Surcharge $ / r 8 e) .001 of Permit Valuation (1/10th%) State Surcharge $ o94 $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ - Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: SUBJECT PERMIT NO. City of Fridley 25543 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT RO. COMMUNITY DEVELOPMENT DIV. I ~ PROTECTIVE INSPECTION SEC. r 1 . i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/26/97 JOB ADDRESS 430 57 Place NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 6,7,8 5 City View Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Marilyn Young 430 57 Place NE 574-9509 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO R & M Associates 3482 Auger, White Bear Lake MN 55110 770-9322 4391 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 B DESCRIBE WORK Reside House & Replace Windows 9 CHANGEOFUSEFROM TO STIPULATIONS Install building wrap and have inspection of same unless manufacturer's specifications state it is not required. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 $ 10,480 $5.24 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. PLAN CHECK FEE TOTAL FEE /Yt/ _ License SC $5.00 $195.47 SIGNATU EAld:.NI�TRACTOR ORAUTHORIZEDAGENT DATE, WHEN PROPERLY V 1DATED THIS IS YOUR PERMIT "" BLO iNSP TIATE S.GNATURE OF OWNER,,F OWNER BUILDER( IDATEI NEW [ ] Effective 1/l/97 ADDN [ ] CITY OF FRIDLEY I ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2�I BUILDING PERMIT APPLICATION p� l ConstructionAddress: A3® Legal Description: Owner Name & Address: / ,�, oTel. # Contractor: �- fY—l� So c = MN LICENSE Address:3 VZ2 n, a,z dl LE F 6c. r f.,, /rc s-!rvo Tel. # �`7& -!g ?Z� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF MIPROVEMENT 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: L��L S Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: - APPLICANT: Tel. # 7Zl — 9 2� c CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $950 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] SUBJECT PE City of Fridley 2 6 4 0 0 AT THE TOP OF THE TWINS BUILDING PERMIT-awetpf r N0. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 3 �� r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 j 612-571-3450 910415 6/29/98 JOB ADDRESS 430 57th Place NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6_7-8 I 5 City View Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS - ZIP PHONE Young 430 57th Place NE 574-9509 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Columbus Exteriors Inc. 2131 111th Ln NW Coon Ra ids MN 701-9569 3509 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION IR REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Siding Re (WEST SIDE ONLY - STORM DAMAGED) 9 CHANGE OF USE FROM TO STIPULATIONS Install building wrap and call for inspection before covering TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNIT$, 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 5500 0.50 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. Fire SIV 0.50 PLAN CHECK FEE FEE T727.00 �� Li e 5.0 SIG EOF CONTRACTOR RAUTNORIZED AGE NT IDATEI NwopALIDA BL .N THIS I$ YOUR PE-��0 '`SIGNATUREOF GATE OWNERIIF OWNERBUILDERI IDATEI NEW ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: o' 5-'2 ) L Legal Description: Owner Name & Address: Contractor: C At ik5' k Address:. S/�U-p ' ''P s A-7✓ Effective 1/1/98 a�a�a�5 Tel. # 5-2 Y' P MN LICENSE #35-67 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT Tel. # .76 / " %S�� % LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/G and Sq. Ft. o.OTHER: ( -y'J E S ( -- / ,(t -S l � SSDCFO Construction Type: 5 S n `— Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: X02 % ' APPLICANT: Tel. # 0 /� S . STIPULATIONS: CITY USE ONLY Permit Fee $ c� CLQ Fee Schedule on Reverse Side Fire Surcharge $ 4D .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ C, $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 [ J Not Necessary [ ] TOTAL $ - O . STIPULATIONS: