PRE 2010 DOCS0
City of Fridley, Minn.
BUR DING PERMIT N® 3444
Date: ........................................ ^
Owner ....................................... Builder ... ............. /l .`�r(ytl+
... .'r'�
Address ...................................... Address ...................... .....................
ATION F BUILDING
No. .��p... Street .... ...-0410,0,07 `...... Part of Lot/� ... .........
.... .... . ...-. ......
Lot ... ..... Block ........ ..... Addition or Sub -Division v►�..CmgA . r-` ;t.. •
Corner Lot ............ Inside Lot ... X ...... Setback �.�. C'� i Sideyard .7 : ...................
DESCRIPTION OF BUILDING
To Used as:
.. .... Front ?.�:O /Depth c2.6..0 Height .,l Sq. Ft 11Vf1 Cu. Ft /.J'Q'I io
..... Front Depth .: ®' Height . � � Sq. Ft. Cu. Ft. 3 .��. 1 00
Type of Construction ..1"51r�Ast. Cost ..................... To be Completed ................... C9
/j, &G
In consideration of the issuance to me of a permit to construct the g de above, a e to do
the proposdd work in accordance with the description above set forth in com with pro 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.
s .. Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, Ing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
is.
SUBJECT
R
City of Fridley
187j
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
ECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
INSPECTION
r PROTECTIVE SEC.
1 �
= CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
10/24/86
DC
JOB ADDRESS 420. - 67th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
5
Rice Creek Terrace Plat 3 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Martin e. Bistram 420 - 67th Avenue NE. 55432 571-3218
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Dick Anderson RR # Brainerd MN Not Licensed) 218 764- 3 28
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
7 CLASS OF WORK
❑ NEW M ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Three season porch, 16' by 16' Wood.
9 CHANGEOFUSEFROM TO
STIPULATIONS
Submit deck plan prior to construction.
Variances granted 10/06/86.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood
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
256
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
$6,100.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3.05
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.
$62.50
$0.00
PLAN CHECK FEE
TOTAL FEE
5.25.00
$80.80
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI 0
W N PROE V L ATTHIS IS YOUR PERMIT
I/!!
.911
4_A(L0 ®SIGNATURE
SDG INSP DRTE
I NATURE OFOWNER (IF OWNER BUILDERI IDA EI
NEW I ] City of Fridley Effective 4/1/86
ADDN. Pg �R-1 AND R-2
ALTER. I ] Building Permit Application
Construction Address:_'� o — (i
Legal Description:--- -7
Uner Name & Address: Tel. v
i �
• •
. I I
Address:
LIVING 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
40- _ O IL vet z
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft. _
-ZZ4 11.9 z yp 40.9146 4 C god ti`. C. 1 oo.Q6
Corner Lot I ] Inside Lot Ft. Yd. Setback Side Yard Setback
Type of Construction: is-iV Estimated Cost: $
Approx. Completion Date: ��Zo to
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: APPLICANT:
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY
Tel. 4
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$475 per SAC Unit
Fee Determined by Engineering
Agreement Necessary I ] Not Necessary I ]
STIPULATIONS: •
Seerh ►t OcaL ik" l.w;► 'N Cewy�t uc t��r
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SUBJECT
PE IT NO.
City of Fridley
1970 5
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
RECEIPT NO.
;,
LL ______ COMMUNITY DEVELOPMENT DIV.
f PROTECTIVE INSPECTION SEC.
3) ��
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
2/14/89
JOB ADDRESS 420 - 67th Avenue N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
5
Rice Creek Terrace Plat 3 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Marty Bistrom 420 - 67th Avenue N.E. 571-3218
3 CONTRACTOR MAIL ADDRESS ZIP PHONE I NSE NO.
Jack Pixley Sweeps Inc. 4179 - 149th Avenue N.W., Andover 422-0�
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 V REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Repair fireplace chimney flue with Ahrens Chimney Tech.
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 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
$2,150
$1.08
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
F ANY OTHER STATE LOCAL LAW EGULATING CON-
ON-
PROVISIOSTRUCT
$54.00
ON OR THE PERFORMANCE OFRCONSTRUCTION.
STRUCTION
PLAN CHECK FEE
TOTALFEE
$55.08
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY ALIDATED THIS IS YOUR PE MIT
•
/�
BLDG INSP ATE
SIGNATURE OF OWNER I IF OWNER BUILDERI IDATEI
NEW i ] City of Fridley
AMN [ ] R-1 AMID R-2
ALTER [ ] Building Permit Application
Construction Address: o O -0
Legal Descripticn: _ Lm -s.
Omer Name & Address : _ '1�laj4v
Contractor: c%C/<
Address:
EEfective 5/1/88
(el. ! , 7/-3a/&"
Tel. #��
Attach to this application, a Certif icate of Survey of the
lot, with the proposoed construction drawn on it to scale.
Length
Length
Length
Corner Lot I ] Inside Lot I ]
Type of Construction:
Approx. Completion Date:
Width
Width
Width
Height
Height
Hgt/Ground
Std.
Ft.
SYS.
Ft -
8q.
Ft.
�'.eoa1 a -7c hl wAle v --F/&P &z Y .% ws CXiirlve%
Ft. Yd Setback Side Yard Setbacks
Estimated Dost: $ lsSo
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: 5 $
'// %%Width + 6' See Back Page
DATE: aA1 APPLIC!M: G�l/A.r'�a2��. .tij?�� Tel.
QTY USE MY
Permit Flee
State Surcharge
SAC Charge
Driveway Escrow
Park Flee
Sewer Main Charge
TOTAL
srIPU MIONS:
5 Flee Schedule on Reverse Side
$.50/51,000 Valuation
5 S9S per SAC Unit
5 Alt. "A" or Alt. 'B" Above
$ Flee Determined by Engineering
5 Agreement Necessary I I Not Necessary I I
0?) SP
?o o Q y3,ov
sy. oz
SuBjECT
PER
City of Fridley
r 90-8
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
COMMUNITY DEVELOPMENT DIV.
v
r I PROTECTIVE INSPECTION SEC.
i
CITY HALL FRIDLEV 55432
NUMBER
REV
DATE
POF
AGE
APP OVED BY
612-571-3450
910-F15
12/4/95
JOB ADDRESS 420 67 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
8
5
I Rice Creek Terrace Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Martin Bistrom 420 67 Avenue NE
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Kallerup Construction 7400 1 Ave S Richfield MN 55423
798-1697 7591
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 N REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage 25 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
MOT.
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
@@ 000
$1.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
`r2 s
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-
$62.25
Fire SC $2.00
STRUCT N OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$70.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
HEN PROPERLY ALIDA ED THIS IS YOUR PERMIT
,BLDG INSP
DATE
S.GNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NEW [ ] Effective 8/l/95
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 C'S
Building Permit Application
ConstructionAddress: ` ZQ 6,7 tt A v L • 1U E— ` _
Legal Description:
Owner Name &Address: !T) a /j 1 j -0j IV-) Tel. #
(
Contractor: �\ q I/ E r, V P rti .n,4 , MN LICENSE #
Address:
T,T,Tel. # 7 9 T'- /6 117
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 Width Hgt/Ground Sq. Ft.
OTHER: �} t " a _
Comer Lot [ ] Inside Lot [ ] Ft. -SetbackYd
Side Yard Setbacks
'
Type of Construction:
r- - 0 T
i�ov-r- Estimated Cost: $ ��U -' 6� a -T)
s
Approx. Completion Date: 12 Z 15-
Z 1-t
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: ! LD
_ APPLICANT:
yc�„�`"%1. U,�-�... �� Tel. # elc�"�9 I
CITY USE ONLY
Permit Fee
$ 6J.
Fee Schedule on Reverse Side
Fire Surcharge
$ t2-
.001 of Permit Valuation (1/101h%)
State Surcharge
$ 0 O
$.50/$1,000 Valuation
SAC Charge
$
$850 per SAC Unit
License Surcharge
$ LIC`
$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 INSPECTION DIV. Effective On January 1, 1997
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 4/ '2-0 7 %-4 4,/ Al, r -_-
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00 $ representations stated in this application are true and correct.
(Side Vent — Fill Out Back) o� •�y 1997
Gas Piping (Needed with new furnace) $ 10.00 $ '
OWNER &dU � t S /1�--� S-7(—
.- %( — Savlo
Gas Range $10.00 $
BUILDING USED AS e
Gas Dryer $ 10.00 $
ESTIMATED COST c?,-- o -n PERMIT NO. �
*Air Conditioning — All Sizes $ 25.00 $
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK
1 % iValue o�ppliance or Work $ No. of Heating Units_ Circle One (Steam) (Hot Water) (V
�� Trade Name Siie o.
Commercial/IndugtrialBTU ��-r� HP ED
1.25% of Value of Appliance or Work $ Fuel Total Connected Load
State Surcharge
TOTAL FEE
$ .50 Burner Trade Name Size No.
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.
BTU
HP
EDR
HEATING COMPANYC���%% G/l-tom p r
Signed By 1��'► ° e �' el No. -�
Approved By Rough—In Date Final Date 0' /3 9 7
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CEMMMY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack.-
tack:1.
1.
Has been carefully examined
Yes ()
No
(
)
2.
Is free from rust or deterioration
Yes ()
No
(
)
3.
Has no foreign objects lodged within
Yes (
)
No
(
)
4.
Is securely supported
Yes (
)
No
(
)
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No
(
)
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes (
)
No
(
)
_ 8.
Has combustion air been provided for water heater
Yes (
)
No
(
)
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
City of Fridley
SUBJECT
P_ a
27597
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
� `
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
V
NUMBER
REV
DATE
9/8/98
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
JOB ADDRESS 420 67th Ave NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
g
5
Rice Creek Terrace Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Bistram 420 67th Ave NE 55432
571-3218
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Erick Kallerup 7400 1st Ave S Richfield 55423
798-1647 7591
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 20 REPAIR
❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof/Tear-off (25 Sq) House & Garage
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
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
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
$2,142.00
$1.07
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---._$74:75.
J "
Fire SC $2.14
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL EE
License $5.00
$82.96
SIGNATURE OF CON TRACTOR OR AUTHORIZED AGENT (DATEI
NP OP R LIDAT
19
el SP
HI$I$ R MIT
r
GATE
SIGNATURE OF OWNER )IF OWNER BUILDER) (DATE)
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address: b ( S r Ct w? Tel. # J 71 ` 3 Z le
Contractor: �` r ( C'- /�� ✓ (%% MN LICENSE
Address: 7/y®z) &e--, S , Tel. # 75���
Attach to this application, a Certificate of Survey of the
5 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 Width Hgt/Ground Sq. Ft.
OTHER:
�7
Construction Type: 1� C �i b 7i , / �, �`b� �` Estimated Cost: $ ��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 16�114e APPLICANT: P /���r . Tel. # 7
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
ylf
.. 10