PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: ... [P...................................
,Owner .......................................
0
N® 3916
Builder �............. .........
Address.............................................
%r
LOCATION OF BUILDING
No. fP. f! .v ..... Street ..6 AVS®.! !.r!+1:.. /-'/ ........ Part of Lot ...............................
Lot ............ Block .................. Addition or Sub -Division .......................................
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION OF BUILDING
Tobe Used as:
(eGG� ........ ... .. Front PV��— P Depth . ... Height . �� . Sq. Ft. .. 7.
Cu. Ft. .... .
. . Depth 10 X "Height t `Q m0 i Sq. Ft. . ... . .
.... Front . � � ../� l Cu. Ft........ .
Type of nstru on ................... Est. Cosi .. lPl. . `...
.s".. . To be Completed :..................
In consideration of the issuance to me of a permit to construct the building desribed 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.
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 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. _
.. 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 Item&
'Ufa
A.
LOCK
ADD
SIOU,
ADDRES S!VALU4TION I&
/YIO TYPE
Property Line
0
I.
SUBJECT
PER- -
City of Fridley
19642
AT THE TOP OF THE TWINS
BUILDING
PERMIT
_
r
CEIPT NO.
i
L COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
G
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
ti.__.11.' �•� 612-571-3450
910415
8/22/88
JOB ADDRESS 680 - 58th Avenue N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
7
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Felix 680 - 58th Avenue N E.
571-2982
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
D & D Home Imp:?ovement 7401 Central Avenue N.E.
784-7543
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 j1 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Aluminum soffit & fascia (house and garage)
9 CHANGEOFUSEFROM TO
STIPULATIONS
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
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
$980
$.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-
ST UCTION OR THE PERFORMANCE OF CONSTRUCTION.
$25.00
or
PLAN CHECK FEE
TOTALFEE
$25.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY
IN SP
IDATED THIS IS YOUR PERMIT
DATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEIBLDG
NEW
[ ]
City of Fridley Effective 5/1/88
ADDN
[ I
R-1 AND R-2
ALTER
I I
Building Permit Application
Construction Address: b cq ® !S-,%Tt\ AVC. /VE
Tegal Description:
Owner Name & Address: -S`f nje Tel.
Contractor: t(1 hf®ft\p J:vnf rcy e m en t Tel. #
Address: e714o ( Cenios i AVB, IVE
Attach to this application, a Certif icate of Survey of the
lot, with the proposoed construction drawn on it to scale.
WIP 0 �M4114:017TIMVPIMMMU
DESCRIPTION OP IMPROVEME:NT
Width
GARAGE AREA: Length Width
DECK AREA: Length Width
Height
Height
Hgt/Ground
Sg. Ft.
Sg. Ft.
Sg. Ft.
Corner Lot [)d Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction:ASM -� LAWN _ I��S e� tJ ag a Estimated Cost:
Approx. Completion Date: — 3
Proposed Driveway Width If New Opening Is Desired: I $
Width + 6'
� fl
Alt. A Alt. B
See Back Page
Tel. #
Permit Flee 5 00 Free Schedule on Reverse Side
State Surcharge S S?) 5.50/510,000 Valuation
SAC Charge 5 $550 per SAC Unit
Driveway Escrow 5 Alt. 'A" or Alt. "B" Above
Park Flee 5 Flee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ I Not Necessary [ I
TOTAL $?)
STIPULATIONS:
SUBJECT
P
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
_19841
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION
r PROTECTIVE SEC.
i "' � CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
•-.-
L 612-571-3450
910-F15
4/21/89
10B ADDRESS 680 - 58th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
7
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Victor Felix 680 - 58th Avenue N.E.
571-2982
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
AMRE Inc. 3700 Annapolis Lane, Plymouth, MN 55447
553-0020
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 Ck REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
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 80 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
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
$5,880
$2.94
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.
$81.00
PLAN CHECK FEE
TOTAL FEE
$83.94
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROP
E Y VALIDATED THIS IS YOUR PERMIT
r
BLDG INSP
44
DATE
'ATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ] Effective 5/
ADEN [ ] R-1 AND R-2
ALTER�j]� Building Permit Application f�
Construction Address : &
Legal Description:
Owner Name & /e!O/z, aA, Tel.
Contractor: L- Tel.
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIMaN OF IMPHOVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
07HER:
Corner Lot [ ] Inside Lot[ ] Et. Yd Setback Side Yard Setbacks
Type of Construction: - Estimated Cost: ZRRCOT
Approx. Completion Date: D -09 A539a
Proposed Driveway Width If New Opening Is Desired: Ft. $ $.
dth + 6' See Back Page
DATE: " i "/9 �7' AppLI /% ' �-
—Tel. #��
Permit Fee $ &0
State Surcharge $ 9
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Charge
,omajoy3 9�
z�)l
V
CITY USE CONLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS:
S5061
0 o o &--
W1
SUBJECT
city of Fridley
7113�58)
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
R
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
y�®��
CITY HALL FRIDLEY 55432
IL
NUMBER
REV
DATE
PAGE OF
APPROVED BY
---- ik" j 612-571-3450
910415
5/27/92
JOB ADDRESS 680 - 58th. Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
7
Donnay I s Lakeview Manor SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
571-2982
Victor Felix 680 - 58th Avenue NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & D Home Improvement Inc. 7401 Central Ave NE 784-7543 4840
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
Reroof Duelling (21 Squares) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 60 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
$1,113
$.56
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
P JOVI ONS F ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$29.00
Fire SC $1.11
STRUTION O THE PERFO MANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
00,
License SC $5.00
$35.67
SIGNATURE ONTRA ORORAUTHORIZEDAGENT (DATE)
WHEN P PERLY VA { ATED THIS IS YOUR PERMIT
7
BLDG -NSP MATE
SIGNATURE OF OWNER 0F OWNER BUILDER) IDATEI
NEW 'I ] Effective 3/1/92
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: bo 5� t*e X/0,
Legal Description:
Owner Name
& Address:
Tel. #�l—�
j
Contractor:
D & D Home Improvement, Inc.
MN LICENSE
# 4840
Address:
7401 Central Avenue N.E. , Fridley, MN 55432
_ Tel. #
784-7543
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Xd Setback Side Yard Setbacks
Type of Construction:J jtl / ~- Estimated Cost: $
Approx. Completion Date:�U�� l5 �%� 9� C;P I `-f'
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE:�7 /?iAPPLICANT: %/d �__.�. Tel. # ZTV-- �
Permit Fee
Fire. Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
$ .29,0C
$ S -GSC+
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not' Necessary [ ]
3uilding PLUMBING Permit No.: —®O (
_nspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd:I ` 3u
)ATE V dA o -T YOUR E-MAIL ADDRESS
;ITE ADDRESS 690 159L"' � NE
FHIS APPLICANT IS: O OWNER 1KC-ONTRACTOR
PROPERTY
Nom: No ewe_ 1',P Synw
OWNER/
ADDRESS: fn00 ellAut OEI CITY !-r(dfe' _ STATEjq9ZIP ,Sq3.')-
TENANT
PHONE: 7l0 3 - S 71 — &3(/j
CONTRACTOR
NAME: inn L- Mjj .vfvn 'T' 0111LI-A PeXA,"(M,
tom_
STATE LICENSE # 53go PM EXP DATE IZ- 31 j 0-7
SUBMIT A COPY OF
YOUR STATE
ADDRESS: 5a2, Vb AV -4 -CITY CITY i�5sac) STATE�lZIP 553C��
LICENSE WITH
PHONE (93 - s"71 - 6 LFS FAX 7L 3 -- 1-a5 -- :Z!t 1
APPLICATION
PERMIT TYPE
SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
0 NEW P(RHPLACEMENT
DETAILED DESCRIPTION OF WORK Lp 4-0 Ga f (C7.1• • rlkf-t u'?,k &W C l_'-w+e_L k4'k, -
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 4A O OV_ x .05 = oA,.. Qd
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON S 10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (rNDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
�_ —
_
BATHTUB —GAS PIPING (nom cnrLjcEh* SWIMMING POOL , WATER SOFTNER ($35)
�_ CLOTHES WASHER KITCHEN SINK _ WATER CLOSET , BACKFLOW PREV. ($15)
_
DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_ _
____ WATER METER —OTHER
Permit Fee $. C)o Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ _ .56 Number of fixtures @ $35.00 x $35.00 = $
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
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
approved plan in the case of,all work which requires review and approval of plans.
� •DoY'+"d- I -le vx
I"VL
SIGNATE OF APPLICANT LJ ouk,- -u DATE
UR PRINT NAME
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX_: 763-502-4977
SUBJECT
PERMIT
City of Fridley
21-975
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
fr PROTECTIVE INSPECTION SEC.
1
G
NUMBER
REV
DATE
PAGE OF
APPROVED By
� /"'1 � CITY HALL FRIDLEY 55432
A J 612-571-3450
910-F15
7/15/93
JOB ADDRESS 680 57th. Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
10
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Syl Jedlenski 680 57th Avenue NE 571-5159
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 IJ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (27 Squares) Second Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd but not the 3rd layer. Provide ice and water
protection at eaves and valleys. Provide adequate attic ventilation. Provide smoke
detectors as per UB.0 1210 adjacent to all sleeping areas and in basement.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED 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
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
$1,458
$,73
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-
$35.00
Fire SIC $1.46
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
le
$37.19
WHEN E Y V D TED THIS IS YOUR PERMIT
BLD INSP DATE
�N7.0OF oNTR OR ORA WZED NT IDATEI/%�
SIGNATURE OF OW IIF OWNER BUILDERI IDATEI
NEW
[ l
ADDN
[ ]
ALTER
[l
Construction Address:
Legal Description:
Owner Name & Ad
Contractor: 0 (J--) 0 F I _ MN LICENSE #
Effective 5/26/93
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Z S�
Building Permit Application
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF fl"ROVEMENT
Tel. #
LIVING AREA: Length
Width Height Sq. Ft.
GARAGE AREA: Length
Width Height Sq. Ft.
DECK AREA: Length
Width Hgt/Ground Sq. Ft.
OTHER: ef, r U 6 /-
/'706,7�e 71-- �� _ Z % S�
s4fCo,-, c/ (/- � /,7- e r. --
Coma Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction:
Estimated Cost: $ A//
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT.
�� Tel. # S 7I-
Permit Fee $
CITY USE ONLY
Fee Schedule on Reverse Side
Fire Surcharge $
.001 of Permit Valuation (1/10th%)
State Surcharge $ '93
$.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
Erosion Control $
Conservation Plan Review $450.00
Park Fee $
Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS: