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PRE 2010 DOCSVillage of Fridley, Minn. 1813 . BUILDING PERMIT IbDate: ...................... ` a Owner....................................... Builder Address...................................... Address ................................ LC)C;ATION OF BUILDING No. .... Street ... ,5.�� ......................... Part of Lot .......... Lot ........... Block .... 7........... Addition or Sub -Division �... . .. ��� .. %yx�s Corner Lot ........... Inside Lot ... ... Setback .. 3 ... Sideyard ......................... DESCRIPTION OF BUILDING To be used as: ,1 v .... Front .7 .. Depth ??.4 S. Height . /.4 ... Sq. Ft. ........ Cu. Ft. ........ ..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction ..... Est. Cost .... 13 . ®.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 ordinances of the village of Fridley. fF..................................................... In consideration of the payment of a fee of $. ;?'. ., permit is hereby granted to p.wt!N7.� ......................... 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 thereofy-shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alt gr tion, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked-- tt any time upon violation of any of the provisions of said ordinances: h -<- „fi'F ........ . ......g Buildin 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. • 11 City of Fridley, Minn. 11 BUILDING PERMIT N® 7361 - � Date: - Owner: ' ��i�Builder Address Address T DIN No. N�`L Part t Lot _ _ ___ Block _ Addition or Sub -Division . Corner Lot Inside Lot _..._.- _ Setback ��__ _ Sideyard Sewer Elevation ____ _ Foundation Elevation DESCRIPTION OF BUILDING To r. FAA �! Front Depth Height &2 Sq. Ft. Cu. Ft. 46 Zgne Front Depth Height Sq. Ft. Cu. Ft. Type of Construction _ _ Est. ilel) -_ 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 IW compliance with all pr ons of ordinanoea of the city of Fridley. J d a 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, repair and moving of buildtQgs within the city limits and this permit may be revoked at any time upon vi of any of the provisions of said ordinances.--, Building Inspector NOTICE M permh don not corer the construcdon, kdailation for wiring, phnubing, gn heating, sewer or water. Be sura to see the Building in:peetar for asparate pwnft for three home. sua�Ecr M of Fridley o 16289 AT THE TOP OF THE TWINS BUILDING P E R M I T _ rpCity R ' � COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �-"I CITY HALL FRIDLEY 55432 "'j NUMBER REV. DATE OF APPROVED BY 612-571-3450 910-F15 7/16/81 / F77 JOB ADDRESS san 630 58t1i Ave, NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 7 Donnay I s. Lakeview Manor Add. SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Lowell Norton 630 58th Ave. N.E. Fridley 55432 571-9286 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 Residential 7 CLASS OF WORK ❑ NEW JJ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Add a 218" X 618" back, door to patio area. 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. wood Frame 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 R-1 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 $500.00 $.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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $7.50 CHECK FEE TOTAL FEE _PLAN $8.00 IGNATUREO CONTRA TORORJUTHORIZEDAGENT (21A91 0Y WHEN PROPERLY VA ATED HIS IS YOUR PERMIT '- BLDG )NSP DATE SIGNATURE OF OWNER) IF OWNER BUILDER) (DATE) CITY OF FRIDLEY APPLICAT194 FOR RLSIDEINTIAL BUILDING PERMITS (New, Alterations, Additions., or Repairs) I OWNER: i'1' DUILDER:- ADDRESS: 43_0_, t; g AVS ADDRESS: . TEL N0: :'', / TEL NO: Construction Location STREET NO: W/ ) STREET: � � �-- LOT: BLOCK: ADDITION:AJ 4 -t -'L"" ede Corner Lot: Inside Lot: �s� Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTIONOF COFlSTRUCTIOPJ 9. • Qo Front: Depth: Iieight: 5- a ewe .DOOR Square. Feet_ Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: 4��(x7D E4_ -o--0— Estimated Cost: $ Rb Be Completed: • � eV) _p Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ • SEE REVERSE SIDE OF SHEET . Me undersigned hereby makes application for a permit for the ♦:ork'herein specified, agreeing to co.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 )c�e true and correct. UNTE: ,! / r�_ � d6 / SICNATURE: Stipulations: City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PE 2 6076 r 1 , ' COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � 1 CITY HALL FRIDLEY 55432 L J` 612-571-3450 NO. NUMBER 910-F15 REV DATE 5/20/98 PAGE OF APPROVED BY JOB ADDRESS 630 58. AVENUE NE 1 LEGAL DESCR. LOT NO. 6 BLOCK 7 TRACT OR ADDITION Donnay s Lakeview Manor SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lowell Norton 630 58 Avenue NE 571-9286 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 J7 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Install basement bedroom window 9 CHANGE OF USE FROM TO STIPULATIONS Window must meet the State Egress Code. 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 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SO. FT. CU. FT. 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 ISTALLS GARAGES 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 VALUATION $500 SURTAX $.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. PLAN CHECK FEE TOTAL FEE 22.00 SIGN R,EOOF�FCOONTTRACTTOORRORRAUTHORIZEDAGENT IDATEI 1�1 �1. / i / AWHEN PROPERLY " 8L'D IN P LIDATED THIS IS YOUR PERMIT •^ ' nATE i NATURE OF OWNMOF OWNS BUILDE I IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: - (� SCJ -- Legal Description: P Effective 1/1/98 Owner Name & Address: lklf--)/ s /(v�o� TQfJ Tel. # :'Z /- 9 2- A Contractor: ' . SIL I - F. MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EVIPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height. Sq. Ft. DECK AREA: Length Width Hgj4Ground Sq. F . OTHER: '21� � Construction Type: Estimated Cost: $ �-(n 0 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ STIPULATIONS: CITY USE ONLY Permit Fee $lam '' Fee Schedule on Reverse Side Fire Surcharge $ �� .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 [ ] . TOTAL $ �a STIPULATIONS: SUBJECT NO. City of Fridley 27454 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. a: ______ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 I NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEV 55432. 612-571-3450 910415 8/31/98 JOB ADDRESS 63058th Avenue NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 7 Donna T s Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 9286 Lowell Norton 571-2 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Eagleview Constr.Inc. 2937 174th Ln NW Andover NN 55304 753-5469 20076043 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 IFIx REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and izarage 24 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the 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 1 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 $2001 $1.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE 2.00 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $74.75 Fire SC 1_.0.0 `off PLAN CHECK FEE 782.75 TAL FEE Licen $5,10 GNATUFfE OF CONTRACTOR ORA UTHORIZED AGENT IDATEI W PR LY VAL A D THIS 1 YOUR PERMjj B G INSFf DATt 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 I A' ConstructionAddress: (v 30�WL� Legal Description: Owner Name & Address: 6&),e Tel. # -5 71 %8k Contractor: � _ MN LICENSE # Address: O`% 3 `7 1'7�`– l�,p�-c Tel. Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: r�vujZ /auu�'_�— Driveway Escrow $ Construction Type: Erosion Control Estimated Cost: $450.00 Conservation Plan Review Park Fee $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: X 311 ` 0p' APPLICANT: Tel. # CITY USE ONLY Permit Fee $ / <i `,l Fee Schedule on Reverse Side Fire Surcharge $ 00 .001 of Permit Valuation (1/10th%) State Surcharge $ /,00 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 6 $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 Q ) � $ 7S STIPULATIONS: Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By:-- 763-572-3604 CITY OF FRIDLEY Date Itc1u M 17 DATE °l ­4 — YOUR E-MAIL ADDRESS SITE ADDRESS i1 THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY NAME: OWNER/ ff ADDRESS: ._ S ya '� /!}U f%1 CITY �'fzL cs� 1e � STATE IP TENANT �3 PHONE: `7 l]' ] 1— CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH PHONE FAX APPLICATION PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW REPLACEMENT 1 DETAILED DESCRIPTION OF WORK �s —av, �. �, '� 0 f 1", rt u e PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES- (INDICAp TOTAL NUMBER OF EACH BELOW) Of _ BATH SINK/LAV _FLOOR DRAINS _ SHOWER WATER PIPING BATHTUB GAS PIPING (vEw cn-yucovm) _ SWIMMING POOL _ WATER SOFTNER ($35) _ _ WASHER KITCHEN SINK CLOSET BACKFLOW PREV. ($15) _CLOTHES _ —WATER DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION — _ WATER METER L--OTHER y y &MIK- Permit Fee $ . Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ CT State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I 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 on 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 plan in the case of all work which requires review and approval of plans. PRINT NAME �Li4v N0rtn4 DATE ��I — ( 7 SIGNATURE OF APPLICANT �./� a k City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 07 O CIWOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, (1 /cam v!, understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a, specific exemption from the licensing requirements. As the owner of the property at r- � o — SS � /-) 0 S , Fridley, am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and 1 understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Date .lding PLUMBING pections RESIDENTIAL APPLICATION 5-572-3604 CITY OF FRIDLEY 9 ! YOUR E-MAIL E-MAIL ADDRESS 7 _i Permit No.: Received By: Date R ADDRESS 3 0 .� )XONTRACTOR APPLICANT IS: ❑ OWNER NAME:L i� L%1 L i ti%�� ZIPNER/ �ADDRESS: P 3 � � - �-, � mANT :PROPERTY pHONE. % (�+ 3 S� GI z c., :ONTRACTOR NAME: Terry Overacker Plumbing, Inc STATE LICENSE # �� y S 502 E Main St ZIP IBMIT A COPY OF Anoka, MN 55303 YOUR STATE ADDRESS: FAQ LICENSE WITH PHONE APPLICATION ('SINGLE FAMILY O TWO FAMILY [3 TOWNHOUSE PEREYPE REPLACEMENT 'YPEORK: NEW ETAILED DESCRIPTION OF WORK 0, whichever is eater� for ER MS 16B.665 the permit fee is a minimum s5.residential fixture excluding the total ding the cost UP so $500 should reflect only the co t of labor ) nprovement, installation or replacement of x.05=�— .abor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor (INDICATE TOTAL OR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: 1PING IUMBER OF EACH BELOW) FLOOR DRAINS _ SHOWER — WATER SOFTNER ($35) _ BATH SI1.iK/LAV — GAS PIPING (NEED M'uc� —. SWIMMING POOL BACKFLOW PREV. ($15) _BATHTUB KITCHEN SINK _WATER CLOSET —FOR IRRIGATION CLOTHES WASHER — LAUNDRY TRAY ,WATER HEATER ($35) _ FOR IR — DISHWASHER — WATER METER Permit Fee $ — Curchar¢e 50 TOTAL DUE $ Number of fixtures @ $10.00 �tlx $10.00 = Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00Sta Such ge = $ 3 0 Total = $ `3 Sj THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED that the work will be in I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that I understand this is conformance with the ordinances and code ofthe City of Fridley and not to start wit ithth e Mi permit; that the wConstructiork w11 be in accordance wnnesoith the not a permit but only an application fora permit approved plan in the case of all work which requires review and approval of plans. //I (. /e PK k? ) ;1 E DATE PRINT NAM 4CK, G SIGNATURE OF APPLICANT �cC� g'f City of Fridley ]Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977