PRE 2010 DOCSPermit Fee paid on Permit #11,315 for 1560-1570 69th Avenue N.E.
City of F 3', Minn.. 1 3 4 0
e
6431 University Ave. N.E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date. _ February 22, 1972
07mer: _ Rice Creek Development Cotapany Builder Approved Contractors, Inc
Address _ 85 West Road, Circle Pines, Minn. Address: _ 1052 Osborne Road N.E., Fridley
786-3680
1660,1662216643 LOCATION OF BUILDING
X0.146=6 1668, �7�g 68th Avenue N.E. p of Lot
arO & � , Section Lot Block Addition or Sub -Division
CorAer Lot Inside Lot Setback Sideyard
Sewer �3evatlon Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: Each Unit
6 TQWnhoijqn.- nit -.q Front __ 2Q1
Depth - 321 Height 21'
Sq. Ft 1213'
Cu. Ft
Front
Depth Height
Sq. Ft
Cu. Ft
Type of Construction Wood Frame
Est. Cost See #13,315
To be Completed
1 year
In consideration of the issuance to me of a permit to construigt the building described ve, I agree to do
the proposed work in accordance with the description above se rth and in compliance all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ See #l_ 1, 31,5permit is hereby granted to Rice Creek Dev. 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
n� city limits and this permit may be revoked at any time upon violation of any of the provisions of said
Or 9
CLARENCE BELI!LE
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sore to see
the Building Inspector for separate permits for these items.
AppRcatioe for Power Pkmft and Heath,% CoangE Vengafte. Rehigeratioe and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: IIATE 'TOTAL
Furnace SheU & Duct Work . $10.00 $
Replacement of Furnace 6.00 $
Repairs & Alterations—up to $500.00 6.00 $—
Repairs & Alterations each add. $500.00 3.00 $—___
MECiL WARM AIR PP
Furnace Shell 6
& Duct Work to 120,000 BTU ..... . ..$10.00 —.0 O
each add. 60,000 BTU .................... .. 3.W ;
Replacement of Furnace .. .... 6.00 $
Repairs & Alterations -up to $500.00 .. 6.00 $
Repairs & Alterations each add. $500.00 &00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $.
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam 9,00
Each add. 320 sq. ft. EDR Hot Water 3.00 $_
OIL BURNER—to 3 gal. per hour 6,00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 188,000 BTU) .. .....
6, .. 6.00�.
c O
over 199,000 BTU See Fee Schedule
Trade Name_:
.�/� size Ne -r � -
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures
x$ 2.00
$ b
Additional Fixtures
x .76
$
Gas Range to 198,000
x$ 5.00
$
AIR CONDITIONING
Cp
0 0
FAN HEATING SYSTEM Son FMSchedule
V ITII.ATING SYSTEM
%l D 0
"t." 06
ALTERATIONS & REPAIRS
TOTAL FEE
a /62, n
7-4
6-0
ROUGH
s� 16.
6
v� < . 'T6
FINAL rl ��
Dept. of Bldge. Phone 680.3490
City of Ridley:
z�_
The undersigned hereby makes application for a permit for the work :herein
specified, agreeing to do all work in strict accordance with the City Ordinance:
and ruling of the Department of Buildings, and hereby declares that an the facts
and representations stated in this application are true and correct.
14/
3L*fr;
Kind of Building
Used as
To be completed about 12%
Estimated Cost,
Old ew. uilding Permit No. Permit No.__ it� 7�p
(REMARKS—OVER$
DESCBIPTION OF WORK
LO
HEATING or PO
PLANTS --.Steam, Hot Water,���++No�
Trade Name_:
.�/� size Ne -r � -
Capacity
Sq. FL E.D.R BTU H,p.
Total Connected Load
Hind of Fue
Q p BURNER —Trade Na.ne
Size No
O / Capaci
Sq. Ft. E.D.R BTU Imo.
(REMARKS—OVER$
City of Fridley
Appkolon for Mmbbig and Cas tag Perath
Dept. of Bldga. Pkone 560-3450DESCRIPTION ®F WORK
..�at�,1l�G� � �loZ
LIU
Number, Kind and LoeaB®a� of PUtussa
1.
a _ ,
•�• ■,MEIM NOW
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES.
NO. RATE TOTAL
$2.00
c�
Number Fixtures ................
. x
Future Fixture Opening ............
x $1.60
$
New Fixture Old Opening ..........
x $1.50
:
Catch Basin ....................
x $3.25
_
$3.00
$L—
Water Beater 'Up to 99,000 BTU) ....
x
New Ground Bun Old Bldg.........
x $3.25
S
Elaetrk Water 16ster..............
s $2.00
$
CAS FITTING FEES-.
NO. RATE TOTAL
lst 3 Fixtures .......... • • • • •
: $2.00
$ /,2.00
Additional lbrtu€es ...............
x $ .?b
$
Gas Mange to 199,000 BTv ............
x $5.00
$—
State Surcharge
$ .50
REPAIRS S ALTERATIO118 — Wer to C®do
_
Deecription 0 ............ A ....................
.... .
s.'
TOTAL F=
-
/�
/ .2 Y -4`�
City of Fridley:
The undersigned hereby makes application for a permit for the work hemi;
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings. and hereby declares that all the fact
and representations stated to this application are true and Correct
Fridley, moi•••• // I9_
owner 2 � e (:7,e—CC& �c�' /401140 e•14
Kind of Building
Used as 2L Y. / !.r N
To be completed about ®c f. T it2
Estimated Cost,
Old—New. Building Permit
ROUGH
Flxu. ,y- i u - 7
Signed
Business
Nn. 5�0
!ter-ir��
SUBJECT
MIT
City of Fridley
32737
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEI NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
PROTECTIVE
1
i 1 CITY HALL FRIDLEY 55432
NUMBER
IEEV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/28/02
JOB ADDRESS 1660-1670 68Th Ave NE
1 LEGAL
LOT NO.
Parcels 10
BLOCK
& 200
TRACT OR ADDITION
Section 13
SEE ATTACHED
DESCR.
SHEET
2 PROPERTY OWNER MAIL ADDRESS 1
Rice Creek Townhomes, 1660-1670 68Th Ave NE, Fridley, MN 5432
NONE
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Rayco Construction Inc., 3801 5th St NE, Col Heights, MN 55421
612-547-3011
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
6 USE OF BUILDING
Apartment buildings
7 CLASS OF WORK
IN NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE - ❑ REMOVE
B DESCRIBE WORK
Re -roof entire roof - tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REOUIRED 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
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
$5,001.00
@
$2.78
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.
$125.25
Fire SC $5.56
STRUCTI OR THE PER RMANCE OF CONSTRUCTION
LAN CHECK FEE
TOT& FEE
OtAtAII0 (0 _CA
Licen 5.00
X138.59
SIGNA1U OFCON7i1 TON Op AUT RI EEO AGENT IDAT I
HE PRO R VAU AT
01
THIS IS Y R PE MIT
_
S-GNATURE OF OVVNERoF OVVNERBUILOERI IDATEI ''
B NSP
MATE
Estimated Cost $ CITY OF FRIDLEY
Receipt # R-39, COMMERCIAL, & INDUSTRIAL 'X3 51,2 3&e/
BUILDING PERMIT APPLICATION be
Construction Address - icy - Zcning
legal
Tel#
-fiuC=' 90 - 6 Tel.# (oiQt-5 Y -3al
Reg.#
BUILDING CONSTRUCTION
TYPE OF W= [] New [] Addition o Alteration -Describe Q,� -
OFC. AREA: Length Width Height Sq. Ft.
*M AREA: Length Width Height Sq. Ft.
arAER AREA: Leagth Width Height Sq. Ft.
APPLICANT Tel 6 Date (o 12ko
VALUATION
Sq. Ft.
x $
cwt/Sq. Ft. =
Valuation
Sq. Ft.
x $
Cost/Sq. Ft. =
Valuation
Sq. Ft.
x $
Cost/Sq. Ft. =
Valuation
TMAL VALUE
Building use Ccrostzucticn Type occupancy GroP
Air CXmditioning [] Yes [] No Fire Protection Provided [] Yes [] No
Performance Bond Am=t $ See Reverse for Schedule Received [] Yes
Permit Fee
$
135, as
Plan Check
$
Fire Surcharge
$
to
State Surcharge
$
SAC: Charge
$
Erosion Control
$
Park Fee
$
Spec. Assessments
$
s3o
$
5: cp
sonar.
$
13 8 .,5C
b0/Z0'd BU BTBL 01
[] No
See Fee Schedule on Reverse Side
In meas of Prepaid A== - See Reverse Side
.001 x Permit Valuation (1/10th 'c)
$.50/$1,000 Valuation (see Sched. for > $1 Million)
$1050 per SAC Unit (Plans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Detexmined By &igineering
Agreement Necessary [] Not Necessary []
feet x $13.50/foot
ATTACH STIPULATIONS
Ai-iQI�w d0 AlIO W02ld ZO:Z1 666T -8Z -N r
AU6-09-2005 13:34 CITY OF FRIDLEY
PLUMBING
RESIDENTIAL APPLICATION
City of Fridley
Permit Number
Received By
Date Received
NOTE: IF PROPERTY 13 NOT OWNER/OCCUPIED. A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT.
DATE
YOUR §MAJL ADDRESS I^�� � �� � �.0�
SITE ADDRESS
THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR_
+ADDRES
PROPERTYS
TENA
STATE ZIP
1® LICENSE#CONTRAS?too STATE If ZIP, �u FAX"
PERMIT TYPE SINGLE FAMILY TWO FAMILY
TOWNHOUSE
TYPE OF WORK p NEW W REPLACEMENT
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED
FD=RES: (INDICATE TOTAL NUMBER OF EACH)
BATH SINKILAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (Need City L/cense) SWIMMING POOL WATER SOFTENER ($35)
CLOTHES WASHER KITCHEN SINK -WATER CLOSET BACKFLOW PREY, ($1y)
DISHWASHER LAUNDRY TRAY WATER HTR ($35) FOR IRRIGATION
WATER METER OTHER
®0
-Permit Fee $ 35— MINIMUM: $15.00 or 5% of cost of the improve hent -Whichever is
Plan Review $ greater on work less than $300
Surcharge $ .50
TOTAL DUE $ , _?57,�' Make checks payable to: City of Fridley
...... '.a nm" •u-rL."Op" "I'm rVR N rCR1VJ11 -� 1VV 1 VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 ppns.
�, / r
NAME OF APPUCANT Z6 DATE �J
PIse hype or print
SIGNATURE OF APPLICANT
OF FRIDLEY COMMUNITY DEVELOPMENT DEPART
$431 UNIYESITY AVENUE NE, FRIDLEY. NIN 55432
-AUG -09-2005 13:34 CITY OF FRIDLEY P. 03/'04
City of Fridley Building Inspections Dept, Ph; 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432 19 1
Mechanical Permit#
Residential Application
City of Fridley
See Back Side For Rena iracf Infnr mat;nn
Date Site Address: 76.
The applicant is: (cirice one)
Owner Contractor
Property Owner-
wnerAddress:
Address:
City:
State: Zip:
Phone:
Cell: Fax:
Contractor Informati�r����p��
��JJ
Company Name:
Contact Person:
Address:ZtAietif f711
City: l-
State: zip-
Phone- ft-<<✓6e�I9A kt—
Cell,: '61-7 EP-ri- Fax:
Email: 1 4 ~/71 MN Bond# &Exp pate .Td3 0�oG
T e of Work (circle one):
New Replacement Alteration/Remodel
Detailed Description of work
Equipment installed: MFG;
Model: Size/BTU:
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply:
_Fireplace (gas) $15.00 New Gas. Grill $10.00
_AIC $25.00
,Fireplace (wood) $35.00 _Gas Unit HTR $10.00
Air to Air exchanger $15.00
_Furnace $35.00 _Pool Heater $35.00
_Boiler $35.00
_Gas Dryer $10.00 Ventilator $15.00
_Chimney Liner $10.00
u --Gas Piping $10.00
Duct Work $10.00
Gas Rangeloven $10.00
Permit Fee $
(Total from above -Minimum fee $35.00)
Surcharge $ — ... -
- _. _ .. - 0.50 -.
Total Due $
Make check Mable to City of Fridley
u ms is an appnration Tor a permit. not valid until processed
I hereby apply for a mechanical 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 1 understand this is not a permit but only an apprication
for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in case of all work which requires review and approval of plans.
Signature of
Approval Ins;
CITY OF FRMLEY PERMIT NO.: 2005-01632
* 6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 08/23/2005
763 572-3604 FAX: (763) 571-1287
ADDRESS 68 AVE NE
PIN . T000053
LEGAL DESC : UNAVAILABLE
: LOT 0 BLOCK 0
PERMIT TYPE : HEATING
PROPERTY TYPE : TOWNHOUSES
CONSTRUCTION TYPE : ALTERATION owl
VALUATION
NOTE: INSTALL GAS PIPING FOR A WATER HEATER AS PER INSPECTOR KEVIN HANSON
j�
v
APPLICANT G S PIPING FEE 35.00
COMMERCIAL PLUMBING & HEA G S ATE SURCHARGE, PLBG FLAT 0.50
24428 GREENWAY AVE TOTAL 35.50
FOREST LAKE, MN 55 25 AID WITH CHECK # 79428
(651) 464-2988
2±1 ER ` 4i
RICE CREEK TOWNHOUSE RP
1336 W TOWN SQ RD v 1
MEQUON, WI 53092- O
AGREEMENT AND SWORN S jNT e 0
This permit becomes null and void if work 'k
ruction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application 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 does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
INSPECTION TYPE
FINAL
CITY OF FRIDLEY PERMIT NO.: 2005-01632
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 08i23i2005
(763) 572-3604 FAX: (763) 571-1287
1660 68 AVE NE PERMIT APPLICANT:
T000053 COMMERCIAL PLUMBING & HEATING INC
UNAVAILABLE 24428 GREENWAY AVE
LOT 0 BLOCK 0 FOREST LAKE, MN 55025
HEATING
: TOWNHOUSES
: ALTERATION
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 5 PM
DATE INSPECTOR INSPECTION TYPE DATE INSPECTOR
INSPECTION COMMENTS:
IN ACCORDANCE WITH CITY ORDINANCE, NEW OR SUBSTANTIALLY REMODELED BUILDINGS SHALL NOT BE OCCUPIED UNTIL ALL
WORK HAS BEEN APPROVED, AND A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED BY THE BUILDING DEPARTMENT.
THIS CARD MUST BE POSTED AND VISIBLE AT ALL TIMES UNTIL WORK IS COMPLETE.
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit #
Residential Application
City of Fridley
See Back Side For Required Information
Date CSS Site Address: e,4
The applicant is: (cirl a one)
Owner Contractor
Property Owner:
Address:/6" E "ewzte�,
City: �i s
State: Zip:
Phone:
Cell: Fax:
Contractor Informati n
-
Company Name:
Contact Person:
r
Address: 4r
City: ��
State: /1?�1/ Zp:Z. S
Phone: 65' jlMel Mee
Cell:6L& 4r Fax:
Email:
MN Bond# & Exp Date
Type of Work (circle one):
New Replacement Alteration/Remodel
Detailed Description of work: A-0'- 6W Ai2ge 44t-iE
moggA i , 1''C
Equipment Installed: MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply:
_Fireplace (gas) $15.00 New Gas Grill $10.00
_A/C $25.00
_Fireplace (wood) $35.00 _Gas Unit HTR $10.00
_Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater.$35.00
_Boiler $35.00
_Gas Dryer $10.00 Ventilator $15.00
_Chimney Liner $10.00.
_Gas Piping $10.00 :-a
A
Duct Work $10.00
,..
Gas Range/Oven $10.00. ^� .,r 1,,:a �
Permit Fee $
(Total from above -Minimum fee $35.00
Surcharge $
0.50
Total Due $
Make check payable to City of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical 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 case of all work which requires review and approval of plans.
Signature of Applicant: Date:
Approval Inspector Signatur Dat -Z52_.5-
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
Building
--PLUN1BTN-G'
Permit No..-Zz 7— 1
Inspections
COMMERCIAL APPLICATION
Received By: 4�
763-572-3604
u
CITY OF FRIDLEY
Date Rec'd: o7
DATE bCO fj YOUR E-MAIL ADDRESS
SITE ADDRESS
TENANT �� SUITE NO.
PROPERTY
NAME: rZ ' S
OWNER/
TENANT
ADDRESS: CITY STATE ZIP
PHONE:
CONTRACTOR
NAME:
SUBMIT A COPY OF
STATE LICENSE # EXP DATE
YOUR STATE
ADDRESS: �'— !i CITY STAT !'w
LICENSE WITH
PHONE6 5/ — FAX S/- ¢(,� - Z S®
APPLICATION
PERMIT TYPE
0 INSTITUTIONAL O MULTI -FAMILY 0 SWIMMING POOL
WNHOUSE 0 COMMERCIAL/WDUSTRIAL 0 OTHER
TYPE OF WORK:
0 NEW PREPLACEMENT 0 ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
huE',:.R' ..r'J
i y o
t-' ^A ws a�?yh',;^ v`�`
AF.y iLa Gs,:: iAy/j�Kc�� �Y'„1 m
..,a,,,.ta'"art
T^Nly 5 MRSHIM, 'C� Lc f} i � � 1.
��z;,�1dLY-..-S:Y
- .iJ..+. <.t .... .hu...-<'i5a
CLOTHES WASHER _ FLOOR DRAWS _ RPZ VALVE _ URINAL
DISHWASHER _ GAS PIPING BACKFLOW PREV. WATER HEATER
DRINKING FOUNTAIN _ GREASE TRAP _ ROOF DRAWS _ WATER METER
FAUCET —KITCHEN SINK _ SHOWER _ WATER PIPING
FLAMMABLE WASTE TANK _ LAUNDRY TRAY _ SLOP SINK _ WATER SOFTENER
LAVATORY _ SWIMMING POOL —WATER CLOSET
£.':`� T , . �n.d' i �'t,:;i t 3..�"._ [ iw x.� :Y.+ '""s^L'ti"Y P � �., r z.'m v`(' � •iv.% !4 :. � .�'"r"'�`.,��1. ie yq.7S` 'k � �x "+ss �.zz.S �'> ,* --..'C Lhi .e�j;c. �..1.-1 "�"!�q j
Total Job $ All fees aze based on valuation, including the cost of labor and materials.
Valuation
Permit Fee $ Jar' (1.25% of Job Valuation / Minimum fee: $35)
Surcharge $ Valuation X .0005
Total Due $,� SO Make Checks Payable to: City of Fridley
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.
J C_ k_5'w "� /0 q
NAME OF APPLICANT DATE
SIGNATURE OF APPLICANT
) a Tye*
City of Fridley Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977