PRE 2010 DOCSCity of Fridley, Minn..
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Mte; August 18, 1972
Owner: _ Ray Price Builder. Same
Address 77 - 75th Way N.E . Address Same
LOCATION OF BUILDING
Na 7 7 Street - 75th Way N.E. Part of Lot
Lot - 5-6 Block Addition or Sub -Division Niemann Addition
Corner Lot Inside Lot X Setback — Sideyard _
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: 28 feet diameter (Oval)
Above Ground Pool Front Depth Height Sq. Ft. _ Cu. Ft.
Front Depth Height — Sq. Ft. Cu. Ft.
Type of Construction _ Steel/Vinyl Est. Cost $900.00 To be Completed 1 month
Stipulation: Permit issued subject to Health Inspectors stipulations after review
of the plans.
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
fhe proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
50 State Surciarge
In consideration of the payment of a fee of $ 6.00 , permit is hereby granted to Ray Price
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
ci limits and this permit may be revoked at a upon violation of any of the provisions of said
Building Inspector
DARREL CLARK
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items,
gs-/ ,d/e,, &4L04
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APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PgRMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM: /` /;�Y L' i';/ C 'L BUILDER : �-e�sr s� l �� �? „•
ADDRESS: ;�>%- y f� ADDRESS: 6✓, ,
NA : , • 7 STREET: % S A -v Al , r
LOT;_,674 4 BLOCK: ADDITION: i*,QA t4W A'�
CORNER LOT: INSIDE LOT: (----SETBACK: SIDEYARD:
,Applicant attach to this form Two Certificates of Survey of Lot and propoved
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As: o �7
tont• Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
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 sttict accordance with the City Qf
Fridley Ordinances and rulings of the Department of Buildings, and heiceby
declares that all the facts and representations stated in this applicatign
are true and correct.
4
UATE: I'F SIGNATURE:
(See Reverse Side For Additional Information.)
Filters of Quality and Distinction
�,
3 POSITION BACKWASH D.E. FILTER
HAIR AND LINT POT
Again Doughboy provides more — a large
5% -inch removable basket assures ade-
quate protection for the pump from
debris. The tremendouly increased area
provided by Doughboy's basket assures
continued flow even though substantial
amounts of material may be trapped in
the basket.
SPI N -SURE @
PUMP IMPELLER
Pat. No. 3,594,102
Another Doughboy first! This impeller
completely eliminates the problem of
corrosion of the steel motor shaft while
running in the water chamber of the
pump.
The rust and corrosion protection fea-
tures mentioned above is actually a secon-
dary benefit. THE PRIMARY FUNC-
TION OF THE SPIN -SURE@ IMPELLER
IS TO PROVIDE SAFETY FOR YOU.
BY TOTALLY ENCASING THE STEEL
MOTOR SHAFT IN AN INSULATING
MATERIAL THERE IS ABSOLUTELY
NO POSSIBILITY OF ELECTRIC CUR-
RENT BEING TRANSMITTED
THROUGH THE MOTOR SHAFT INTO
THE WATER CHAMBER OF THE PUMP
AND SUBSEQUENTLY INTO THE
SWIMMING POOL.
II
HEAVY DUTY PUMP
AND MOTOR
Doughboy's new whisper quiet pump is
the result of proper engineering and the
application of hi -impact molded products
to provide a pump which is impervious to
pool chemicals and completely corrosion
free. The combination of the SPIN -
SURE@ impeller and the heavy duty
pump provides greater flow during the
entire filter cycle.
Standard models available
• 1/3 H.P. - 9% sq. feet filter area
1/2 H.P. - 13% sq. feet filter area
(W :h off -on switch)
:3/4: H.P. - toi%sq. feet filter area
(with off -on switch)
BALANCED FILTER
ELEMENT ASSEMBLY
The newest and most efficient interlock-
ing element construction known to the
swimming pool industry.
The ELEMENTS ARE SPACED ONE
FULL INCH APART to provide proper
flow and distribution of the filter aid and
to assist in a high level of efficiency for
filter cleaning.
Each individual element grid has scientifi-
cally engineered orificing to -provide for
total hydraulic balance through the entire
element assembly. It is the coupling of
this hydraulic balance in each grid with
the balanced design of the POSI-LOCK@
manifold itself that provides a totally
balanced system.
RELIEF-O-MATIC@
Patent Pending
This EXCLUSIVE DOUGHBOY FEA-
TURE removes the necessity for manual
release of air from the filter system on a
daily basis, as the automatic system is in
operation at all times.
CLEAN-O-CATOR@
o0�6ABp�
z�
i
i
t1"
!lpB;B;6!
BACKWASH INDICATOR GAUGE
Patent Pending
This EXCLUSIVE DOUGHBOY FEA-
TURE provides a complete non-mechani-
cal indicator to tell the operator when the
filter unit is in need of backwash cleaning.
POSI-LOCK@
GRID MANIFOLD
DES. PAT..No. 218,518
PAT. No. 3,536,195
This EXCLUSIVE DOUGHBOY FEA-
TURE provides for the positive rotation
of the grid assembly. Each grid and each
spacer is independently locked to the
permanent manifold system, thus assuring
positive element rotation to provide
proper cleaning.
Another important feature of the Posi-
lock@ manifold is balanced hydraulic flow
during filter and backwash cycles.
w�
x
THREE POSITION
BACKWASH VALVE
DOUGHBOY'S EXCLUSIVE THREE -
POSITION VALVE is designed for com-
plete filter cleaning with the minimum
amount of effort on the part of the oper-
ator.
Doughboy's valve has a positive locking
position in all three operating zones; thus,
avoiding the inadvertent movement of the
handle during filter operation.
By merely rotating the handle in a clock-
wise direction (approximately one quar-
ter of a turn) with a slight upward pull,
the valve will find its own internal guide-
way and slide upward to the next
position.
1. FILTER POSITION
With the valve in this position
POOL the water flow pattern is that
which is required for normal
filtration of the swimming pool
PUMP ° and -is also correct for the addi-
FILTERR tion of the filter aid to the unit.
d
2. BACKWASH POSITION
With the valve in this position
the entire force and flow of the
pump surges on a reverse pattern
®Doughboy Recreational
Domain Industries, Inc. 10959 Jersey Boulevard, Cucamonga, California 91730
thru the element assembly for
proper cleaning. The process of
cleaning the grids from the in-
side out combined with positive
rotation assures the ultimate in
PUYFIL4R
cleaning.
3. VACUUM TO WASTE
The Vacuum to Waste position
WASTE
is designed to allow you to
vacuum an extremely dirty swim-
ming pool directly out the waste
port without contaminating the
filter unit itself. In addition to
this very important function,
you may also empty the pool by
using a vacuum set or other suit -
PUMP
able suction I ine and again pump-
ing the entire volume of the
water without the necessity of
forcing it through the element
WASTE
assembly. -
®Doughboy Recreational
Domain Industries, Inc. 10959 Jersey Boulevard, Cucamonga, California 91730
WeP _ - Res
RIGID 10" TOP DECK WITH BULLNOSE CONSTRUCTION o MASSIVE 8" WIDE VERTICAL SUPPORT COLUMN
WITH FEATURE STRIPE oSAFETY ENGINEERED TOP CONNECTORS oCORRURIBBED STEEL WALL WITH HEAVY
GALVANIZING PLUS BONDERIZED PAINT FINISH ON INTERIOR AND VINYL COATED EXCLUSIVE DECORATIVE
WAVE PATTERN ON EXTERIOR -LASTING BEAUTY AND PROTECTION o 20 MIL EXPANDABLE COLD CLAD®
DURAFLEX® VINYL LINER 4 10 YEAR LINER WARRANTY * WALL PRE -PUNCHED FOR DOUGHBOY'S
THRU-WALL SKIMMER AND RETURN FITTING.
32'z16'Model �21
ULD CLAD' EXPANDABLE LINER
The above sketch shows how Silverline, special quirements of the family increase.
Newport or special Crestline models can be
deepened. The Cold Clads Duraflex® liner can Doughboys exclusive Cold Clads formulation al- _•
be installed initially at a 4 ft. depth or at a lows year round Installation, in that, the vinyl
graduated depth from 4 ft. to 7 ft. If initial will not shrink or crack at temperatures as low
installation is at 4 ft .• the pool may also be as 351 below zero. Cold Clads liners in 20 mil
excavated at a later time, as the swimming re- thickness are covered by a 10 -year warranty.
Monterey Oval Model Available*
Model No. Size
3026-27 32'x 16'x48"
Pe�
Gal. Cap. Flat
13.600
*U.S. Patent No. 3,522,614
APPROX.
Gal. Cap. Exp. Shp. Wt.
15.540 - 84" deep 1199#
reaiur��
STANDARD CRESTLINE MODELS:
APPRM_
• RIGID, 6" TOP DECK
• MASSIVE, 6" WIDE VERTICAL SUPPORT
COLUMNS
• SAFETY ENGINEERED TOP CONNECTORS
• 20 MIL, COLD CLAD@ DURAFLEX® VINYL
LINER
• 10 -YEAR LINER WARRANTY
• EXCLUSIVE EXPANDABLE LINER OPTION
GALVANIZED STEEL COMPONENTS WITH
BAKED ON VINYL PAINT
• WALL PRE -PUNCHED FOR DOUGHBOY'S
THRU-WALL SKIMMER AND RETURN FITTING
Model No.
Size
Gal. Cap.
Shp. Wt.
3615-00
15'x48"
5,288
402 #
3618-00
18'x48"
7,616
486#
3624-00
24'x48"
13,536
616*
EXPANDABLE CRESTLINE MODELS:
APPRffY
Model No.
Size
Gal. Cap. Exp.
Shp. Wt.
3615-17
15'x48"
5,971 - 66" deep
408#
3618-17
18'x48"
8,600 - 66" deep
495#
3624-17
24'x48"
17,190 - 84" deep
627#
0
City of Fridley
AT THE TOP OF TME TWIN$
r L------ COMMUNITY DEVELOPMENT CIV.
1 PROncTIVR I"OftcTION DgPT,
CITY NAIL FAICI.RV 0604
.J 44-900-3400
879.01
53-84�x
'tJmoEGT
PLUMBING PERMIT APPLICATION
.Ioo aaaress
77 NE 75th Way
ner
Address Phone
Ray G. Price
Same 784 7775
Contractor
IVIINNEGaSCO Address 732 MARQUETTE AVEN& one
Kind of Building
Use
Frame
Res.
Completion
Date
Estimated Cost
2/5/74
10.00
i I I �i
Plumbing Fixture Rates: NO. RATE TOTAL
�Ij�
Ii Number Fixtures x $2.00_
i Future Fixtures x $1.50
aflNva
SVD
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New Fixture -Old Open. x $1.50
1dd1
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Catch Bastn x $3.25
SY9I
Water Heater -99,000 BTU x $3.00
i
•*SINI
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Ground Run Old Bldg. x $3.25
eaa,
•enNlva�
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Elec. Water Heater x $2.00
sNlavel
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Gas Fitting Fees:
04—
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lst 3 Fixtures x $2.00
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Additional Fixtures x$ .75
tl
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Gas Range -199,000 BTU x $5.00
SAVal
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HSYMI
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ERepairs
& Alterations I
rR0UYLACE��'�
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Description:Repl (1) Gas Range Code 3.00 �
YNISYYI
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State Surcharge Class IAI SurchargO .500, .50
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TOTAL FEE $ 3.50
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s,YNlan)
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!The undersigned hereby makes application for a permit
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for the work herein specified, agreeing to do all work
6.090*12
in strict accordance with the City Ordinances and rulin
asAYM
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I
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
applic&ttpqI_am4&. true and �core.
W
'Signature `. ' pate
"
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES AW
JOB ADDRESS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work
Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the
Furnace Shell and Duct Work, Burner - city codes and ruling of the Building Division, and hereby declares
Also Replacement Furnace $ 20.00 $__110 _-02 that all the facts and representations stated in this application are
true and correct. Sem- 30
Gas Piping (Needed with new furnace) $10.00 $
OWNER Af'�'e
Gas Range $10.00 $
BUILDING USED AS Art
�Sr o4l, 7_1 •0�6
Gas Dryer $ 10.00 $
ESTIMATED COST 'S, 030, — PERMIT NO. 141e I
*Air Conditioning - All Sizes $ 10.00 $ /0, 010
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $ Z No. of Heating Units_ Circle One (Steam) (Hot Water (Warm Air
Trade Name (b wti-0,.,_ i'.mnJG Size NoG=b 60
Commercial/industrial BTU &c>,Aa,•a HP EDR
1 % of Value of Appliance or Work $ Fuel N4T' J& 4-S Total Connected Load YN cw a
State Surcharge $ .50 Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE $ 3Z.5'0
HEATING COMPANY j 7-,,-,,
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed By !::a Tel No. 511-3 Q 8 �-
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00 Approved By (;;eE Rough -In Date Final ..Lo
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND BTACR 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
( )
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
Remarks
List Alterations Being Done:
teras 741 t -�)a µh tP e %Ci Ain A�"1-,J
HEATING COMPANY ecu 7 o
Signed By X
Date
City of Fridley
SUBJECT
P€RMf N0.
2
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r � �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
7/30/96
JOB ADDRESS 77 - 75th Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
5-6
Niemann Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Rose Price, 77 - 75th Way N.E., Fridley, MN 55432
571-7775
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Goodell Construction, 1998 Rice Creek Road, New Brighton
55112
633-2065 6963
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 I REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Re -roof (tear -off)
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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 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
$1,732.50
Fire SC $1.73
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-
$56.75
$.87
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
00
PLAN CHECK FEE
TOTALFEE
"-� �9,�.
License SC
$5.00
$64.35
SIC ATURE 0 CONTE TOR OR AUTHOR) ED AGENT (DATEI
WHEN P/ROPS Y VALIDATED THIS IS YOUR
(itd /
BL INSP
yPERMIT
/�
O � J✓ b W
DATE
_
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
r •:
NEW [ ] Effective 3/1/96
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: ;-2j— e&)5::� A 4
Legal Description:
Owner Name & Address: cs s G Tel. # 7 7 7 17
Contractor: LIZ MN LICENSE # �o
Address: 7 8' c c /%�`,, a� Tel. # (9 3 3 Za
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF E14PROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Grounds� Sq. Ft.
OTHER: al-l-',�/J S6 LS \I k Z '�O
Corner Lot [ ] Inside Lot [ ]
Type of Construction:
Approx. Completion Date: _
Ft. Yd Setback Side Yard Setbacks
Estimated Cost: $,Z ,
(Cost: on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: APPLICANT:
M9
Tel. #
TOTAL $
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ 5z 75"
Fee Schedule on Reverse Side
Fire Surcharge
$ 1-73
.001 of Permit Valuation (1/10th%)
State Surcharge
$ k ]
$.501$1,000 Valuation
SAC Charge
$
$900 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 $
STIPULATIONS:
Building
BUILDING
Permit No.: 7
Inspections
RESIDENTIAL APPLICATION
Received By: QQ
763-572-3604
CITY OF FRIDLEY
Date Rec'd: 7-®,L
DATE % _ Z (O - O (�
YOUR E-MAIL ADDRESS
SITE ADDRESS `7 -2 `7,�'
✓cls /
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: -et21e Pr,, e
ADDRESS: 77 `y� k-)dy lVtl--- CITY `�1 ; i ��i
STATE&rk ZIP 5— y.3 2-
TENANT
PHONE:
CONTRACTOR
NAME: (n Pa A P.-
STATE LICENSE # Z n z 9 Z y g Y EXP DATE -3 - 31 0 -7
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: .6-(a Y( re-e /V CITY S/
�rSTATE,!2,gIP-6—�Z
WITH APPLICATION
PHONE /- 3 9 - y3 z o FAX
PROPERTY TYPE
WINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
13 ADDITION Op ARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH OOF ❑ DRAIN TILE
13DECK 6 SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: `-e ro ; , 'F
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING_
❑ HOUSE ONLY
NUMBER OF SQUARES Z 5 %MOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS, & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I .
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes [No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 3Or) I - OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ -®�
$ 1 . S�1
$ S•00
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks savable to: City of Fridley Attach
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 whic requires review and approval of plans. �//j
SIGNATURE OF APPLICANT 1t nom / ��� PRINT NAME 4,114 T ! /c.�P�/Po DATE (0