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PRE 2010 DOCSr Village of Fridley, Minn. BUILDING PERMIT ° 1823 Date: ..... ...P� ...........`.......... / Owner....................................... Builder ..G�/=.::.. Address ...................................... Address ...'a'�.�... �.... ..... .......� LOC4TION OF BUILDING No. 9�.... Street .... � 7.� ...................... Part of Lot ................... Lot ... ...... Block ......�........ Addition or Sub -Division .. �..3 Corner Lot ... Inside Lot ........... Setback .. V..... Sideyard ... 1A ..................... DESCRIPTION OF BUILDING To be Use as: ...... ..... Front :!.. �. Depth �- . � Height � ........ ........ Sq. Ft. Cu. Ft. C............ Front XP... Depth .e�.L... Height .. Sq. Ft. ........ Cu. Ft. ........ yp�!? Type of Construction ..... ®®�........ Est. Cost . t 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. In consideration of the payment of a fee of $ � � � 1�!'... • :' :;:;; = . • .. ° . p ym .. ,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 village 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 items. ANOW �\� \� \�\\� ���� . IP" � � \\� »� . � �} \ ` ` \ IP" --p 00 NO 01 c Q"VW7 City of Fridley, Minn. 9730 BUILDING PERMIT • Date: May 13, 1968 Owner. Dale Maur Builder Chuck's Const. Co-. Address 490 67th Ave. N. E.Address 3800 Hajes St. N. E. C� • LOCATION OF BUILDING No. 490_ Street 67th Ave. N. E _ -- part of Lot Lot 15 _- Block 5 Addition or Sub -Division . Rice Creek Terrace Flat A 3 Corner Lot - Inside Lot _ _ Setback --- Sideyard --.- Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage Front —12L Depth 24 ' Height --10 1 C � Sq. Ft. Cu. Ft. Family Room Front 14' Depth 201 Height Sq. Ft. _ _ Cu. Ft. Type of Construction game Est. Cost _ $4, 000 -- To be Completed __._ In consideration of the issuance to me of a permit to cons the building described above, I agree to do the proposed work in accordance with the description above set rth and in. compliance with all provisions of ordinances of the city of Fridley. � /// /) --)A Y In consideration of the payment of a fee of $ 20,00 . permit is hereby granted to Chuck s s Const. Co. 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Clarence Belisle , NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or wafer. Be sun to no the Building Inspector for separate permits for these Bona. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNLR' d NAME UILDER ADDRESS Z' -it a11�-c /� � ADDRESS 0_ _C'._ .•� . • _ ... ZOCATIQ�i. OF .$t�LDI��3 .. _. N0.. LOT . BLOCR _ADDITION Oil SUBD7CVISION CORNER LOTy INSIDE LOT SETBACK SIDEYARD SEWER ELEV,.TION `� . TOP OF FOOTING Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. SDESCRIj7-1ON 0,F BUILDING To Be Usld� ASCr Front • Depth Square feet SZg Cubic Feet 1 7iont Ai Depth ' �7 G$eight_ &---6 Square feet Cubic .Feet • =3� Type of Construction Estimated Cost'.��' To Be Completed 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. DATE _ _ ._ _— _SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). ANOKA COUNTY 6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55421 April 5, 1974 Dale Maur 490 -67th Avenue N.E. Fridley, Minnesota 55432 Dear Mr. Maur: This construction season, the City of Fridley, is improving 7th Street by laying bituminous sur- facing and concrete curbing which is adjacent to your property. The street will be widened to 441. Presently your redwood fence is located within City right-of-way. It will be necessary to relocate the fence back to your property line prior to construction. The City of Fridley will relocate the fence as an incidental cost to the street construction project.. Actual work on this will be completed prior to in- stallation of curb and gutter. We hope that you' will plan for the relocation, and that this will be of minimum inconvenience to you. Should any questions arise, please contact me at 560-3450, extension 61. REH/pl Ve ly yours, Ronald E. Holden Sr. Engineering Aide SUBJECT PER City of Fridley 11 2 0 413 AT THE TOP OF THE TWINS BUILDING PERMIT 'f , T R N COMMUNITY DEVELOPMENT DIV. v 3&5 _ / 3& SS r PROTECTIVE INSPECTION SEC. i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/8/90 JOB ADDRESS 490 - 67th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 5 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP 571PHO- 0867 Avenue Arland Breyer 490 - 67th N.E . 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Wescot Construction 85 East County Road "B" 488-1984 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 Construct a, 12' x 16'- Addition B'digging 0-10 lity,10taboo&` j r 9 CHANGE OF USE FROM TO�+\" #Y LAW {r/ STIPULATIONS. variance a,�proved 5/22/9-0 to reduce. the required side yard setback on a corner lot tQ 149", See notations on plan. On all new roofs or tear -offs and replacement roofs, State Code requires that 2 layers of 15 Ib. felt, S fpAR mopped together, Abe lostalled to 4 point 24 inches. A r up from exterior grafi, lino, or tW use of other wIR/NGs pEj� crane. � /rs approved underlaym A TING, p�U Ell!/RSD BI1VG R AN %do0va TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS I 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 $11,000 $5,50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SACCHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OFYLOCAL LAW REGULATING CON- $126.00. ERFO CO TRUCTION�. STRUCTION ANC PLAN CHECK FEE TOTAL FEE $131.50 SIGN TUREOFCONTRACTORORAUTHORIZEDAGENT ID EI HEN PR P V LI TED THIS IS YOUR PERMIT 6A 1 BLDG INSP � SiGNATURE OF OWNER qF OWNER BUILDERI IDATEI NEW [ ] CITY OF FRIDLEY Effective 1/1/90 ADDN] • R-1 AND R-2 ATS [ ] Building Permit Application Construction Address: O 601-1- Legal Description: Owner Name & Address: $ g -e- Tel. Contractor: Wrfs L ®'r Address: _bS .�{- �sl.�-•� � Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. IPTIC�T OF neru EI m ��- � LIVII�IG AREA: Length I �' width 1 c® Height o1 Sq. Ft. 2 6 GARAGE AREA: Length Width Height Sq. Ft. DDQt AREA: Length Width Hgt/Gramd Sq. Ft. OTMR: Corner Lot K Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: "y , o � Estimated Cost: $ Approx. Ocanpletion Date: 11,060 Proposed Driveway Width If New opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: 2 16(0 APPLICANT: _ ►k W - weS cot. # "C �� -i a 19 4-- -ags el CITY USE Omy Permit Fee $ Ia(160 Fee Schedule on Reverse Side State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $600 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] SI'IPULATICKS: 1 �r'�� ®� V j �, � Vries C456- cures. 3.J ' Gies r o y.. a. f CERTIFICATE OF INSURANCE STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois T1�1t�t- try ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois Naxen Of ft!WyhoWer aamaas of Poft"O er { 4 ..y�i�'►�n�.--:� — ..� ..., s... atie .. ....,ie enA Il.nlfc :eu�f�nfee4 halnw 'Aggregate not applicable it Owners', Landlords' and Tenants' Liability insurance excludes structural alterations, new construction or demolition. THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS. EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED tef d lot to - T_ — y�a /'Te o rizad Representative Title F'tTM: POLIOY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY :: r^ Comprehensive}.1 eneral Liability q T —' r (� -" `i J' ❑ Dual Limits for: BODILY INJURY Each Occurrence $ Manufacturers' and Aggregate $ Contractors' Liability PROPERTY DAMAGE Owners', Landlords' and J Tenants' Liability Each Occurrence S The abov, insurance includes NZA (applica6 it indicated by ®1 PRODUCTS -COMPLETED OPERATIONS Aggregate' $ j OWNERS' OR CONTRACTORS' PROTECTIVE LIABILITY Combined Single Limit for: BODILY INJURY AND CONTRACTUAL LIABILITY PROPERTY DAMAGE ROAD FORM PROPERTY DAMAGE ROAD FORM COMPREHENSIVE GENERAL LIABILITY Each Occurrence $ Di'i Aggregate [ffY_ NUMBER TYPE OF INSURANCE POLICY PERIOD (etf.iexp. CONTRACTUAL LIABILITY LIMITS (If different than above) BODILY INJURY ❑ Each Occurrence $ PROPERTY DAMAGE Each Occurrence S Aggregate $ ❑ EXCESS LIABILITY ❑ Combined Single Limit for BODILY INJURY AND PROI�ERTY DAMAGE ❑ Umbrella Other Each Occurrence $ Aggregate $ 1 STA r Workers Compensation Part`�'1308 RY and Employers I Each Accident $ � 4 — Liability l rr Disease -Each Employee Disease -Policy Limit 'Aggregate not applicable it Owners', Landlords' and Tenants' Liability insurance excludes structural alterations, new construction or demolition. THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS. EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED tef d lot to - T_ — y�a /'Te o rizad Representative Title CITY OF FRIDLEY Effective May 1, 1990 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE -RESIDENTIAL RATE TOTAL lob Address Furnace Shell and Duct Work, Burner (Also replacement furnace) $ Gas Piping $ 20.00 10.00 2, � 0 0 $=— $ /0' cp� Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Tel. 4571-34SO (piping needed with new furnace) Gas Range $ Gas Dryer $ 10.00 1Q.00 $ $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. • Air Conditioning (all sizes) $ All Others/Repairs and Alterations it of Value of Appliance or Work 10.00 $ $ Fridley, Minn. J'(,;Pv-e OWNER A✓6C>?" 0 KIND of BUILDING t COMMERCIAL/INDUSTRIAL USED AS 12-o gr 1 d Prl e 1% of Value of Appliance or Work $ TO BE COMPLETED AB�ODUT ESTIMATED COST ,4 C).OL �f State Surcharge TOTAL IRE $ .50 $ ULD -HEW BUILDING PERMIT NO. PERMIT NO. Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough Insp. Date F ins 1 Insp. 46 —1-54 — Date Approval for Permit 641 MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 PLUS $.50 STATE SURCHARGE •Air Conditioners can not be placed to side yard witlkout written permission from adjoin►nq nkrullklx,r. HEATING or POWER PLANTS, Steam, Hot Water, Warm Air/- No. Trade Name Size Mo. /1✓2/ls-%� f) Capacity ���01LD _ Sq. Ft. EDR BTU HP / Total Connected road Kind of Fuel 4-T14.� S BURNER - Trade Name Size No. Capacity Sq. Ft. EDR 87V MP Company signed By ) \ ` A Tel. No. fill out out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes (,+�" No ( ) 2. Is free from rust or deterioration Yes No ( ) 3. Has no foreign objects lodged within Yes (L4 No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes ( ) No ( ) 6. Has Total heating BTU t s of All other BTU's����`� TOTAL `(O, Remarks Company (IS756 In ro. 2 s C c. Signed By Qr,��� Da to L //— /i'�; 01 SUBJECT PER Mg — - City of Fridley 20477 AT THE TOP OF THE TWINS BUILDING PERMIT - wo. 1, _ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. Ct "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 7/16/90 JOB ADDRESS 490 - 67th Avenue N.E. 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. is15 5 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Arland Breyer 490 - 67th.Avenue N.E. 571--0867 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Exterior Design Service 6391 Monroe Street N.E. 571-3220 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 REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Alum/Steel VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 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 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 $6,500 $3,25 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- $90.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $93.25 N TURE OF CONT RACR A HOR1ZEDAGENT IDATEI WHEN PROPERLY VALIDATED T21S YOUR PERMIT pr 7 SIGNATURE OF OWNER IF O NER UI DER) MATEI BLDG INSP 4ATK 01 NEW [ ] Effective 1/1/90 ADEN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: Legal Description: Owner Name & Address: Contractor: Address: 6 d ) Tel. #S711 49 F� e P' - n Tel. Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION of narIOVEMENr LTM G AREA: Iength Width Height Sq. Ft. GAMM AREA: length Width Height Sq. Ft. DBCR AREA: Length Width Hgt/ Sq. Ft. 07HM: Corner Lot [ ] Inside Lot j ] Ft. Yd Setback Side Yana SetbacJs Type of Construction: Estimated Cost: $�— Approx. Completion Date: Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: APPLICANT: Tel # .�-7e- Pennit Fee State Surcharge SAC Charge Driveway Escrow $ 90,o $ 3 a� S CITY USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] ICTAL $ 93-.24 ST PU=C M: J'�- 66 C c SUBJE& P . N City of Fridley 28515 AT THE TOP F THE TWINS BUILDING PERMIT RECEIPT NO. 1.572-36� COMMUNITY DEVELOPMENT DIV.�� v r PROTECTIVE INSPECTION SEC. E 1 NUMBER FEv GATE PAGE OF F/ AonpOVEO BY CITY MALL FRIDLEY 55132 �'"'"�• ��� 612-571-3450 910-F15 111/4/98 JOB ADDRESS 490 67th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 5 1 RixRKR CH Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Chuck Carlson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Exterior Design Service571-1920 39-47 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 0 ADDITION 0 ALTERATION Nx REPAIR O MOVE 0 REMOVE B DESCRIBE WORK Reroof house and garage (30 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building 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 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 I 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 2571 $1.29 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE P VISION OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- S CTIO ORT EE PERFORMANCE OF CONSTRUCTION $74.75 Fir C 2.57 �/ PLAN CHECK FEE T7T�VE II/ -q- %y Licen 1 IGNATUAEO CON'RACTOR OR AUTHORIZED AGENT IDATEr N 01PRO VALID E HIS IS YOUR PERMIT r I S,GNATURE OF OWNEA,IF OWNERBUILOERt IDATEI B G INS TIAtE NEW ADDN [ ] ALTER [ ] ConstructionAddress: Effective 1/1/98 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION & '� < I > I "Ok . Legal Description: Owner Name & Address: r qe k Axp- 6'&4 Tel. # Contractor: bs cA . p- > Del -:0 0 ,,, se_r vac MN LICENSE # Address: &037!/ ,yep e 7V, � �� Tel. # 0---71 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. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Construction Type: AWEstimated Cost: $��1 (Fee Schedule on Back) Driveway Curb Cut Width Needed: F. + 6 Ft = Ft x $ _ $ DATE: — APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1 / 10th %) State Surcharge $ Z 2g $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ . Ob $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: