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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N? 2993 Date `°�.: ......... Owner r „' Builder ..... . Address . sy .�. �.. �..... �..�t.,.� .............Address..;�.,,.. �... ... ter.. ,r..a+i,C......... LOCATION OF BUILDING; No. . +... P i,i.. r Street .............. Part of Lot . � ........ Lot ............... Block . Addition or Sub -Division Corner Lot ........ ... Inside Lot ... .J.. Setback DESCRIPTION OF BUILDING 0'_ To be Used as: an FrontDepth .weight ... Sq. Ft. Cu. Ft, .. �4' . Front ........ Depth ........ Height Sq. Ft......... Cu. Ft........ . Type of Constructio It? ......... Est. Ck* To be Completed ^: i q' � � 6if: I•..�`Z:�' A� � W-V'"'„/p.�� �' � � � :rte✓ ������� / z, }" /7 Ineo"nsfit1Te i�"sue`o permit7c11-ed g described above, Iagree to do the proposed work int' accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. In consideration f the payment of a fee of $...f 't is hereby granted✓to ................ .................... .. to construct the buildinge ad i ition 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 with- in the village limits d this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: This permit sewer or water. •y•=.; _ ,A��. ,_ a"✓.�. 'Building s not cover the construction, installation or alteration for wiring, plumlJT_ng, --as heating, sure to see the Building inspector for separate permits for these j,ems. • • City of Fridley, Minn. BUILDING PERMIT N® Date: ... 3 ............ .... ........ Address 3703 Builder ...da ,llt ........................... Address............................................. I/ � L J►TIONN OFFBB ILDING ... Street .....*-2n.-. /. 1p! :' , s ...... Part of Lot ............................... ........ Block .................. Addition or Sub -Division ........................-.............. oraer Lot - ......... Inside Lot ............ Setback :: ...�.:... Sideyard ..�. ° :: . /: w DESCRIPTION OF BUILDING To be Used as: _ `d:•i: .rJ..... Front ..L:.. ( " Depth ✓".'. Height l% : .L r Sq. Ft. /..%fir-.. Cu. Ft. .................... Front ........ Depth ........ Height ........ Sq. Ft......... Cu. FL ........ Type of Construction ................... Bat. Cost..................... To be Completed ................... -X,f- In consideration of" 1 e issua4ee to me of a permit to construct the building dealbed 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. f ' ° :. :.�:.::::........ :.. � .:...... .. In consideration of the payment of a fee of $J:� .:' .�... , 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. j 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. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name � Fs Builder Address �� Address LOCATION OF BUILDING No`.-QgEr Street Part of Lots � - LotS���Block --Add. ition Addition .or Sub._ Div: Corner Lot 4';24 /, 1:l'E lmsid'e Lot r Set Back . Applicant attach to this: form Certificate of Survey of 'Lot and proposed building location. DESCRIPTION OF BUILDING To be used as / 1::-rj/, i2* Z�v 0 G Front_ AVG Depth W, height Sq. Ft. ® Cu. Ft. 2 -7-O Front -Depth Hight Sq.,, Ft. Cu. Ft. ..._.._.._ Type of Construction Estimated Cost__,. To be completed The undersigned hereby makes application for a permit foe the work' herein specified, agreeing to do all -work in strict accordance with the City Ordinances and ruling of the Department of.Buildinge; and hereby declares that all the facts and representations stated in this application. are true and correct. Date Signature (A Schedule of Fee Costs can,be,found on the Rever4e Side) n A City of Fridley Appiication for dumbing, and Gas Fitting permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK ;L-3 4 5 Number. Kind and Location of Fixtures Location PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 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 .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ Qp TOTAL FEE '0 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 applicatin eeytrue and correct. Fridley, Plrinn_i lg Owner Kind of Building Used as Tobe completed about �F ' / '`' Estimated Cost, $ / Moo )Y(C New uilding Permit ®� By Business Phone No- Connection o 19 19 Connection Permit No . ....................................................... L/ Water _ Sewer Z= Y Z K K Z Z O S wU' C9 Z N WATER HTR. 3d m� 3 o� �� $ a3 �g �� �p F N cAs ELEG Base /Z 1st f 2nd 3rd 4th • Fuiure Connection Openings Connected with New Fixture, Old Openings I Sewer Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 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 .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ Qp TOTAL FEE '0 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 applicatin eeytrue and correct. Fridley, Plrinn_i lg Owner Kind of Building Used as Tobe completed about �F ' / '`' Estimated Cost, $ / Moo )Y(C New uilding Permit ®� By Business Phone No- Connection o 19 19 Connection Permit No . ....................................................... L/ Water _ Sewer 11 IM -8-58 Meter Deposit City of Fridley SUBJECTPE 14329 AT THE TOP OF THE TWINS BUILDING PERMIT • ` IPT NO • COMMUNITY DEVELOPMENT DIV. i I.y------, INSPECTION /yl r � � PROTECTIVE SEC. P a �J { C/ t/ NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 � �'J i•"'� 612-560-3450 910-F15 8/29/77 JOB ADDRESS 232 - 58th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Wli 8, 9,10 26 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Avis J. Wessman 232 - 58th Avenue N.E. 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE- X 8 DESCRIBE WORK Construct a 22' x 24' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. WARRING �E MIRED FOR WIRING. SEPERA PERMITS Q Betote 41ging call focal utilities HEATING, PLUMBING AND SIGNS TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAW 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 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 'HEREBY CERTIFY THAT I 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,907 $1.95 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. $21.12 PLAN CHECK FEE TOTALFEE $23.07 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY YALIDATED THIS IS YOUR PERMIT BLDG )NSP •.1y-9? DATE IGNATUREO NER IIF OWNER BUILDER) (DATE) i • CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PE HITS NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: �/�� s � W � SS�%'�i�%1� BUILDER: Address: -2 3 2 5��' /�irrp, �%% Address: oApo ) Tel. No.. rY No.: -2 3 Z Street: . LOT: (it -6 BLOCK: 40�-2, 6, ADDITION: © _ CORNER LOT: INSIDE IAT: STBACK: SIDEYARDS: Applicant attach 'to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To'Be Used As: DESCRIPTION OF BUILDING Front: Z _ Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: (.:,� �� Estimated Cost: $ To Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $�/ (SEE REVERSE SIDE OF SHEET) 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. See reverse side for additional information. DATE: �2, z q _ 77 SIGNATURE: //%�f C • 6A) Stipulations: AGREEMENT_ owner of the property located at���it�f' have no objection to the City allowing the construction of a ��'� to be located at c -?3,Z ' j- &cL without the required certificate of survey that the City ordinarily requires for all new construction. r Signature 6 � �) —e� Address Z'- -,Z;7 Date r Witness sueJEcr PE T NO. City of Fridley - 1713 0 AT THE TOP OF THE TWINS BUILDING PERMIT r • _____ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 73 9 N CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 15/10/83 JOB ADDRESS 232 58th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. glnr 76 a Park SHEET 2 PROPERTYOWNE MAIL ADDRESS ZIP PHONE Dennis Kollmann 232 58th Avenue N.E. 296-6689 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW y(] ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK stairway to the basement 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, WOOCI 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 SOO.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .5O 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. ePLAN 64 n Ll A.0I D~ CHECK FEE TOTAL FEE 15.50 IDATE� SIGNATURE OF CONTRACTOR OR AUTHORIZED RL�AGT_4 HEN PROP I AT D HIS IS YOUR PERMIT vVci( N�Q�,.lt 0. - -- VII BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) i CITY Of FRIDLEY Effective Aug. 1, 1961 APPLICATION F014 RESIDENTIAL BUILDVIG PE -HITS (New. Alterations. Additions, or Repairs) OWNER: /"-5 L //�Yi 2 L1 ?I J ADDRESS: 93) 5S11 -AIQ- x1b . TEL Mo: BUILDER: _ 5 w' -P ADDRESS: TEL NO: Construction Location . STRICT 110: -5q m �e STREET: LOT= tLoocs �_'� ADDITION: Corner Lot: Inside Lot: _ setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth= Height: square Feets Cubic Feet: Front: Depth t Height: square Fest: Cubic Peet: Type of Cbrstructions Mstimated Cost: 0"00 9b be Cor-pleted: Alt. A Alt. 8 proposed Drive++ay Width If Now Opening Is Desired: SEL REVERSE SIDE OF SHEET zi:e undersigned hereby makes application for a permit for the work herein specified, Agreeing to do,all work ba strict accordance with the City of Fridley Ordinances and ruli"gs of the Delyarteurt of buildings, and hereby declares that all the facts and representations stated in this application are true and correct. D6%7Zt SIGNAM E : stipulatiosss: LD r Building B JIULI}ING Permit No.: UU >__ Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: DATE YOUR E-MAIL ADDRESS CAS 0- SITE ADDRESS _� — SS+—L— hA_a, f\:Yi, THIS APPLICANT IS: ❑ OWNER PGONTRACTOR PROPERTY OWNER/ NAME:�� ,� . TENANT ADDRESS: CITY PHONE J - (A(p,3 —STATE—ZIP CONTRACTOR NAv1E:_ The Home Depot A.H.S. Inc. SUBMIT A COPY OF STATE LIC 3200 Cobb Galleria Pkwy. YOUR STATE LICENSE ADDRESS: Atlanta, GA 30339 CITY STATE ZIP WITH APPLICATION PHONE 763-542-8826 ❑ SINGLE License #20268257 'E PROPERTY TYPE ❑ TWO FA _ .ORIES PERMIT TYPE QADDTTION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWD vflNG POOL TYPE OF WORK: ❑ 1,MR' ❑ ADDITION ❑ MAINIWANCEJREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: (cf / ;Qla 4FA,14T S . Ft. SIZE OF IMPROVEMENT LENGTH WIDTH ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES 0 HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ v"myl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project `WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 1, 2 3Q s OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 16 3 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ q_ .001 x Permit Valuation (1/10%) License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) 'urb Cut Escrow $ ft + 6 ft = ft x $20 = $ erosion Control $ $450 Conservation Plan Review 'ark Fee $ Fee Determined by Engineering >ewer Main Charge $Agreement necessary ( } Non Necessary ( ) notal Due $ , ( Make checks payable to: City of Fridley Attach Stiuulations THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a )ermit but only an applicati for a permit and work is not to start without a ermit; that the work will be in accordance with the approved clan in the case of all work ch require ew and appy f plans. ,IGNATURE OF APPLIC PRINT N ✓A ICa (_ fl� - .ATE 10 v ,� Building $ BUILDING Permit No.: inspectionsRESIDENTIAL $65% APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY Date ' _)ATE .5 Gt It) YOUR E-MAIL ADDRESS a o d i 5 d) t l d --r J 01y s. c o m =LTEADDRESS P32 '54601 .icense Surcharge THIS APPLICANT IS: ❑ OWNER 15CONTRACTOR $5.00 (State Licensed Residential Contractors) 'ROPERTY OWNER/ NAME: O del A'r n d 4 TENANT ADDRESS: PW 57%1" ABY c ArLC. CrrY a[ Ct [ y STATE zIP SSt13 7 PHONE: 7(.3 j 50 2 - G L L 3 rosion Control CONTRACTOR NAME:_ THD At- Home Services, Inc. Jodi 4D Ode Jo at ark Fee STATE LIC 2690 Cumberland Pkwy, Ste 300 ; q Sa ( 3 Ys • (, o y 7 SUBMIT A COPY OF Cumberland Office Park $ YOUR STATE LICENSE ADDRESS CITY STATE ZIP WITH APPLICATION PHONE Atlanta, GA 30339-3913 ❑ SINGLE Lic# 20268257 Ph. 763/542-8826 �E PROPERTY TYPE ❑ TWO FA .'ORIES PERMIT TYPE 17ADDMON ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH -&,ROOF ❑ DRAIN TILE ❑ DECK 1 SING ❑ OTHER ❑ SWMO DNG POOL TYPE OF WORK: ❑ NEW ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 1 -1"064. y fn oU el O p i S n e >1ZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. :OOFING❑ HOUSE ONLY � JMBER OF SQUARES -B.HOUSE & GARAGE BASEMENT REMODELING SUBMIT: =1RAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan _ .OPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan ' OPOSED HEIGHT: 3. List of structural members to be used !'DING FOR NEW CONSTRUCTION INCLUDING DECKS, - Vinyl []Soffit ADDITIONS. & PORCHES SUBMIT: Muminum ❑ Trim 1. Site Plan/Survey showing the existing structures Other ❑ Fascia and proposed project. "INDOWS 2. Two sets of construction plans EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations 2 FOR NEW OPENINGS -DESCRIBE SIZE OF ENING CHANGES & iPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ "Ri '? 15`7 OCCUPANCY TYPE ' ermit Fee $ 121,35 See Back Page for Fee Schedule 'Ian Review $65% of Building Permit Fee urcharge $ 'a (.0005) times the total job valuation —Minimum $.50 ire Surcharge $ .001 x Permit Valuation (1/10%) .icense Surcharge $ (jQ $5.00 (State Licensed Residential Contractors) AC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) . rb Cut Escrow $ ft + 6 ft = ft x $20 = $ rosion Control $ $450 Conservation Plan Review ark Fee $ Fee Determined by Engineering ewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Iotal Due $ Q (, _ q 9 Make checks Davable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in Dnformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a srmit 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 tan in the case of all work whichrequiresrev'ew nd approval of plans. GNATURE OF APPLICANT Lam, PRINT NAME _ (� / • ! ,J / 1 11 DATE 4