PRE 2010 DOCS9
SUBJECT
PER
City of Fridley
® 128 16
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
1. `L _.__�_ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION
'�
r SEC.
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
1 /22/74
JOB ADDRESS 1429 - 76th. Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
27
3
Meadowmoor Terrace Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Dahlmeier Construction Company 8460 Cottagewood, Spring Lake Park
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 401 x 1 Dwelling and a 241 x 201
9 CHANGE OF USE FROM TO
STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before
capping.
SEWER LOCATION: Service extended 49.51 East of Manhole (Inv. 890.61)
Top of Footing: 894.00 Minimum
WATER LOCATION: 101 North of Sewer Service.
SEPERATE PERMITS REQUIRED FCR WIRING,
HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
12,-1
960
24,480 Total
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I 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,
11.55
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT,
$23,100
DOES NO RESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIA.. OF ANY OTH ATE OR LOCAL LAW REGULATING CON-
STRUCTIO OR THE PE RMA CE OF CONSTRUCTION.
$46.00
$300.00
PLAN CHECK FEE
TOTAL FEE
jg� %
" 0 7_7
$357.55
SIGNATURE OF CONTRACTOR OR AUTHORIZED AdENT (DATE)
HEN PROPERLY VALIDATED THIS IS YOUR PERMIT
c
y,
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG )NSP DATE -
9
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT -
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME : � ' BUILDER: 6
ADDRESS :N;Oa ADDRESS : 77'/ '
U U
NO:. 1qQ 9 STREET
LOT:7 LOCK:_ ADDITION:
CORNER LOT: INSIDE LOT: Z-- SETBACK: IS SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front: Depth: � Height:
{
Square Feet: ev Cubic Feet: -
/
Front: Depth: Height: w
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost:
rT
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 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: v�-�--✓�� C ,
(See Reverse Side For Additional Information.) '
3
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-------------------------------
M5-Af*iraj 09 A(E.
Ladsirwymy
ENGINEERING, INC.
Owl & mwwa vl ff�rset a sow
En ineers Sur vectors --
cemmu&zcate off' suavre w �lv aars�r AwD 46EX5
r Tlo
NORTH
40
76 T" / vE.
IL
:k
a-_ 102.11
INSla
? vI
7
J �3
a&A1,OTE'S IRON Q,�W9;TS ffll-lTY 4 D�QA/11fAG.�' EASEMENT
I' SOT B4 a0,� ACADOI+/ V OR TRRAC.�
calNTY of ANoXA
wrlrPy fW **,s a /nye aid cffm f vpmseo&hw #/',tsw-viey 0& da�-f e* � des"W lmd,wd
o0e /ocafian q'oH bnild*.s . #mmi , mad d� rrs��i axnvadimenfs , ��'�,y, �rn or rr r /send As wrweyed ly ow tki_ d j
SUBURBAN ENGINEERING , INC.
67 ws fr 5urrlljra
&&,c Ay
9tl8 C
City of Fridloy I
Applicffi®n for Plumbing end G= Ming Nmft
Dept. of Bldga. Phone 580-3430
DESCRIPTION OF WORE Lomtia, �g-9 �( -`�Xalf
Number, Kind and Location, of Fixtures
ffi
I;
lC
I
_
"�
'�
S�
`"
7
N
7$
►
a
WATER MTR.
GAS
ncc.
Base
13"
2nd
_
3rd
4th —
I
I
I
-
1-
-1
-
-4E
Future Connection Oponlnfls Sever
* New Fixture, Old Openings Cesspool C]
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ x $2.00 $ %
Future Fixture Opening ........... 2—• x $1.50 $
New Fixture Old Opening.....:.. x $1.50 E
Catch Basin .................... x $3.25 $
Water Heater !Up to 99,000 BTU). • .. x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Electric %Vator Hostas. .......... .. s $2.00 $
:.AS FITTING FEES: NO. RATE TOTAL
Ist 3 Fixtures x $2.00 $ .
Additional Fixtures ............... x $ .75 $
Gas Range to 199.000 BTU ........... . . x $5.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ........................................
TOTAL FEE $
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
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 tact
and representations stated in this application are true and correct
Fridley, Nun -/ % 192
Owner ,ql/'n i/'. -ins ,
Kind of Building '.L- of
Used as ' 'j
To be completed about
Estimated Cost, $ � y 0
Old—New. Building Permit No. Permit No.
Signed e_zn�� 0
ROUGH
FINAL / : -'05
.50 State Surcharge
By _.
Business Phone No-
Description
o
GMAYITg WARM AM:
F%Wnace Shell & Duet Fork
Replacement of Flurnare
Rcpai- lie Alterations ---up to 5500,00
Repairs & Alterations each add. 5500.00
Id CIL W AM Ant
Furnace Shell & Duct Work to 120,000 BTU
each add. 60.0041 BTU
Replscernent of Furnace
Repairs & Alterations --up to $500.00
Repairs & Alterations each add. 5300.00
STEAM as HOT WATER ZYSTEX
A17'a��� nc �r'7a a sys"eons Dowd
Dept. Of B14CM &'h*n* SM -3"M
RATE TOTAL Lo=�� 21e 1'/
$10.00 $
6.00 S
600 S
300 S
41000
S
3.t10
E
6.00
5
6.00
$
3.00
5
FPsrrace Shell & Lines— to 400 sq. ft FMR Steam MOO $
Furnace Shell. & Line—to 640 sq. ft. EDR Ilot Water 1000 S.
Each add 200 sq. ft. EDR Steam A rA $
Each add. 320 sq. ft EDR Hot Water 3.00 $
OIL BURNEF.—to 3 gaL per hour 6.00 $__—,
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to L99,000 BTU) 5.00 5
over 199.000 BTU Sot Fes Schedule
GAS FITTING FEES. NO RATE TOTAL
1st 3 Fixtures x$ 200 S
Additional Flstures x .96 S--.
Gas Range to 2S9,C 5
State Surcharge .50
,A
f1o® Fes
. TOTAL F=
City of Fridley:
The undersigned hereby makes application for a permit for the work herew
specified agrc�-ing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the farla
and repr"s-niatiuns stated in this application are true and correct.
Fridley, Minn =Z
r a
Owner
Kind of Building
Used as
To be completed about
Estimated Cosi~ S ,114 y
Old rew
Building Permit No. P®rmit Ho. Q.26
HEATING or POWER PLA1"T'S--Steam, Not Water, Warm Air—No—.L—
Trade
irr—NNo—.L—Trade Name 9_l��� Size Noz
Capacity. _. - _ g4. Pt &: D.R BTV ® eo MP
Total Connected Loadg 2 � Of S9ae
BURNER — Trade Name gist 240
Capacity Sq. rL ED -a BTU
t M>t.-0m1
ay `8419 CENTER PU
NNEARMIS, -MIMESOTA 55412
DIMCMIFTIOP3 or WORK
Number, KivA emd Iwsmiau of nxta%%
PARTIAL RATE SCHEDULE
PLUMING FIZ P IMS:
1606 RATE TOT"
Numb Fixtures ................
x am
FWUM Mature CIX-ning .... ® ......
A
x $1.50
3_..
New Fixture Old Opening ..........
% $1..510
=
Catch Bath..................
x I&M
Water Beater !Up to 99.000 RTIP ....
x $3.00
$
New Ground Run Old Bids.........
x
S
--
Elei Water Hester. . . . . . . . e .... e
`$3.25
x $2 o
0113 1•ITTIIdO FEES.
No. RATE TOTAL
lot 3Fixtures ......••••.••••:•e._x3.00
=07A2'®
&4k"tioaai $73tttim ...............
s $ .75
$
Ors Rai to MM STU ............
x $5.00
3
• State Surcharge
$ .50
MMAMS & ALTERATIONB —R Fes Be
.0.... . C ...�.y . a.. . es
�.
r5�� !? 2,� d4A4-
�iCTI i . r 7'S
The =deasia ned hereby names application for a permit fog thv vork hese^
specified. eariveloff to do all work in strict accordsncO with the CSS c -e
and runag of the Department *I.Bufldlags. and hereby declares that 01 the 9act
and to stated In this applicatim an areae and correc%
—T — Q -S W 1 l S2:�
Oweer B.OAA"C���
Kind of Building � �•
City of Frialoy -
APpiicimtioii for Pfumbii'19 CidGm- p Pe=lt
Dept. of Bldtsx. Phone M-3450
DESCRIPTION O: WO= �� C
Nu*3bar, Kind and Locel;en of Fixtures
• Future Conaoc:ku Opoainrr► �I a.on.=v�`+u "jam �� •
e ?dais Fixture, Old Oyeair4z Sasser Cl
Cc :spool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ................
x $2.00
$
Future Fixture Opening ...........
x $1.50
$ _.
New Fixture Old Opening..........
x $1.50
Catch Basin . . . . . . . . . .. . . . . . . . . .
x $3.25
$
'Water Beater 'Up to 99.000 BTU) , • • •
x $3.00
$
New Ground Run Old Bldg....:....
x $3.25
3
Electric Water Haataa, , , ... , .....
z 52.00
$
3A.S FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ............ • • • • • •
x $2.00
Additional Fixtures ...............
x $ .75
$
Gas Range to M.000 BTU ...........
x $5.00
6
ONNOWNI
�M
MENI�va
NO
wml
_rrr��sIvrrrn���
• Future Conaoc:ku Opoainrr► �I a.on.=v�`+u "jam �� •
e ?dais Fixture, Old Oyeair4z Sasser Cl
Cc :spool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ................
x $2.00
$
Future Fixture Opening ...........
x $1.50
$ _.
New Fixture Old Opening..........
x $1.50
Catch Basin . . . . . . . . . .. . . . . . . . . .
x $3.25
$
'Water Beater 'Up to 99.000 BTU) , • • •
x $3.00
$
New Ground Run Old Bldg....:....
x $3.25
3
Electric Water Haataa, , , ... , .....
z 52.00
$
3A.S FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ............ • • • • • •
x $2.00
Additional Fixtures ...............
x $ .75
$
Gas Range to M.000 BTU ...........
x $5.00
6
City of Fridley:
The undersigned hereby makes application for a permit for the- Work herei
specified, a„Teeing to do a'1 wcrk in strict accordance with the City Ordinance
and ruling of the Dep..'.ment of Buildings, and hereby declares that all the fad
and representations stated in this application are true and correct
Fridley, Minn
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit No. Pamit No.
Signed`-
By—cs-��'-'
Busins Phune No
ROUGH
REPAIRS 11, ALTERATIONS—Aafar to Code .50 State Surcharge
.Description .........................................S
TOTAL FEE
SUBJECT
PER
City of Fridley
15 7 7 7
AT THE TOP OF THE TWINS
BUIL DING PERMIT
7
�
R
`V ____ COMMUNITY DEVELOPMENT DIV.
�y
% �(
r PROTECTIVE INSPECTION SEC.
�
( V
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/11/80
JOB ADDRESS 1429 - 76th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
27
3
Meadowmoor Terrace SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
LeRoy Nelson 1429 - 76th Avenue N.E. 784-8432
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Nedegaard Construction Co., Inc. 3903 Foss Road 560-0070
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO,
6 USE OF BUILDING
Res ide nti..al
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 816" x 42 Entry Additionto Dwelling (69 from foundation)
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS.
WARNMG
8elote digging can local utilities
TELEPHONE - ELECTRIC - GAS Etc.
REQUIRED BY LAW
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
SQ. 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. OWLG. 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
$1,500
$.75
DOE O ESUME TO GIVE AUTHORITY TO IOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
P O ISIONS F ANY OTHER STATE OR LO L LAW REGULATING CON-
S C OR THE ERFORM N E OF CO T CTION.
$9.00
PLAN CHECK FEE
TOTAL FEE
hrIffo
$9.75
sl NATUREOFCONTRACTORORA ORIZEDAGENT I ID EI
WHEN PROPERL VALIDATED THIS IS YOUR PERMIT
BLDG INSP DAT
SIGNATURE OF OWNER IIF OWNER B UILDERi IDATEI
coil p
-------------
• P
As
_ 1
F41, f
CITY OF FRIDLEY -
APPLICATION FOR RESIDENTIAL [BUILDING PERMITS
(Neer, Alterations, Additions, or Ilepairs)
0WNER: s�
ADDRESS:
TEL NO:
BUILDER: - -D
ADDRESS:- :3qo
TEL NO: S-E0—vo t7, C)
Construction Location
STREE, T NO: STREET:
LOT: BLOCK: ^ �^ ADDITION :
Corner Lot: Inside_Lot: _ Setback: -Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
gop Front:
Square.Feet:
Front:
Square -Feet:
' 11101 r_1C0&
Depth: I Height:
Cubic Feet:
Depth: Height:
Cubic Feet:
00
Type of Construction: wow a S- -u cc Estimated Cost: $ i
To Be Cbmpleted:
Alt. A Alt. B
Proposed Driveway Width if New Opening Is Desired: _ $ $
SEE REVERSE SIDE OF SHEET .
T1le 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 applicati a true and correct.
n
DATE:� SIGNATUM
Stipulations:
• e7Y .� .
. l
condgen ' ° � 2 �rs.y *cs A16.
ca,dsawyny
Sols ks/uj.J
ENGINEERING, INC.
_ C►nl fr Mwrxipvl S!/mef d-6066
byffeemy-- En yineers Sur veyors --
NORTH
LOT 27 1
--76 ASE
N E , � � 35 � w' � 411
7
\�
102 it
o
c;
witcz
4J
;
aIJC 1,07SS /RON !1T/L/rY ORA/NAGZ EASEMENT
oc IZOT__L. WIRgA CC
CAYNrY OF A/NQXA
/ ff"a y W14'' #W *6 is o Irina and awa�f repro -w ofran o`'o surrey qr#x bwndor�es �('Ae o6ff dmcf ► d land, &V
o�'flx lacvfta►i q/'ol/ ddmgs , Iltira, , and d/ nsib/t axrovrhinertfs , i,!'a► , fu ar at sad /arx! As wi rental m�e /Ari dx
SUBURBAN ENGINEERING, INC.
iI
L_1 ew 11 J% 1
I
SUBJECT
O. I
City of Fridley
28677
AT THE TOP OF THE TWINS
BUILDING
PERMIT
572-3604
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
SEC.
r PROTECTIVE INSPECTION
a'Y
I � ,
NUMBER
REV
DATE
PAGE OF
APPROVED By
I CITY HALL FRIOLEY 55432
L J` 612-571-3450
910-F1511/30/98
JOB ADDRESS 1429 76th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
27
3
iMeadowmoor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Larry Nelson
-
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
LaFrance Exteriors 342 McKinley St. Anoka -
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 O ALTERATION JR REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (24 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPYLATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
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
2056
$1.03
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARIS
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
IF
STRUCTIO I OR THE PERFORMANCE OF CONSTRUCTION
$74.75
J Fire C $2.06
PLAN CHECK FEE
TOTAL EE
ON'RACTORORAUTHORIZED AGENT IDATEI
SIG uulr
EN PeR/p/V
IS YO�I.1� PERMIT
$�GNATURE O� OWNEROF OWNER BUILDER, IDATEI
9l DG $P
/ r
f1ATE
w
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 /` 1
BUILDING PERMIT APPLICATION
ConstructionAddress: %
Legal Description:
Owner Name & Address:
Contractor:
Address:
0'
r�
)X/1
Tel. # 7671/— — Wig
MN LICENSE #±200F1971
Tel. # 7/gil—
Attach to thiY application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER:
DESCRIPTION OF IMPROVEMENT
Width Height
Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
V d
Construction Type: Q2 Q�v Estimated Cost: $�S�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: — � �9APPLICANT: O'%/ Tel. #
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 [ ]