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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT • Date: March 3, 1970 • owner: Allan C. Mattson Bider Gerald Eich Builders Address 6320 Riygrview Terrace Address 1454 -18th Avenue N.W. LOCATION OF BUILDING No. P467 Street �79 th Way N ,E . Part of Lot Lot___ Block 1 Addition or Sub -Division . Spring Brook Park Corner Lot _ Inside Lot — X Setback _ _ _ Sideyard r Elevation 827.80 _ 831.80 Wye Top of Footing DESCRIPTION OF BUILDING �3�7 N° 10565 To be Used as: Dwe 1 1 ; r�g& Gar. . Front -W- Depth 27' Height 2_Q ' Sq. Ft. 1350' Cu. F't. 27,0 0' Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame Fist. Cost _.i3,QQ4_ To be Completed 4 Months SEWER LOCATION: 113' West of Manhole WATER LOCATION: 10' East of Sewer 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 city of Fridley. Q b In consideration of the payment of a fee of $ 50.00 , permit is hereby granted to Gerald Eich Bldrs . 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 andmoving 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. QIAR�WCE BELISLE NOTICE: This pared! does not cover the coestwction, indaMoe for whing, plumbing, gas hewing, *ewer or water. Be wre to an the Building hopector for separate permhs for these Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER 'S NAME �%�¢� BUILDER G ADDRESS G302 ADDRESS /1W LOCATION OF BUILDING NO. 461 S 7 fA LOTS X `! CK ADDITION OR SUBDIVISION ✓ �• CORNER LOT-3422l—INSIDE LOT -Z _SETBACK SID ARD SEWER ELEVATION TOP OF FOOTING Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. r DESCRIPTION OF BUILDING1,2 To Be sed'As: Front '--)—® Depth 7 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 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.) NOTE: A Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceeding with the framing. _ ti ok- f°,5 PLANNING COMPdISSION MEETING - FEBRUARY 18, 1970 PAGE 2 lot. Otherwise they will only be able to build one home. Chairman Erickson asked if Mr. Henriksen owned all of the lots involved and was told that he did. Mr. Mittelstadt asked how close the house next door was? Mr. Mattson e--plained that there would be 31)' separating the two homes. Chairman Erickson asked if Lot 1 was a corner lot? Mr. Clark explained that neither lot was a corner lot. There are no corner lots involved. Chairman Erickson asked if there would be garages on the proposed buildings? Mr. Mattson explained that both homes would have tuck -under garages. He continued that as he understood it, these were the last two lots on the block that it was possible to get building permits for because the land then slopes to the flood area. I Chairman Erickson commented that the 50' home would only be 6 1/2' from the lot line and a 10' clearance is needed where there is livable space. There is livable space above a tuck -under garage. He continued that they would need a variance from the Board of Appeals in order to get a building permit. Mr. Mattson aaked if he didn't still need the lot split first and was told that he did. Chairman Erickson inquired if the second hom was 72' back from the lot line. Mr. Clark said that it was 52' back from the lot line. Chairman Erickson commented that because the setback could only vary 6' from the avers a of the setbacks of the•homes on either side, Mr. Henriksen would also need a vAriance for the second proposed building. He was proposing a setback of 35 and the average is 44 . Chairman Erickson continued that Mr.' Henricksen should check with the Building Inspection Department about the var 1, I ances to see if he would be able to get a permit to build. a Mr. Mattson asked if the building had to be 10' from the lot line if there garage is a within 31 of the lot line? t Mr. Mittelstadt explained that the living space must be 10 feet from, the lot line and a tuck -under garage has livable space above it. Mr. Jensen noted that there had been no new legal description supplied. Mr. Clark stated that the petitioners were told that they would have to I supply a new legal description, but it did not have to be for this meeting. It would be a simple description. 10 9 N? 5124 Original Permit for UMBING AND GAS FI ING C 7y N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit O® inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of thisFee $ permit., DESCRIPTION OF WORK Number. Kind and Location of Fixtures Stories m CW W D Q J U m 4 Z K � € m Q m t 2 m Q m m Y 2 m I m 4 1- m Q Y ; t Y Z Z] 2 O D LL m w O = (p R Z O C J C LL p = Z F to Q Q U m 3 Z K Q O K J x i LL m a Q d O Q W m t Q a O C' WATER HTR. GAS ELEC. Basement let ® l 2nd 3rd 4th Connected With Sewer -Cesspool Gas Piping for Openings Permission is hereby granted EMAdIA4 b1l, . to do the plumbing and gas fitting in the building described in statement hereto attar d, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Inspector. Final Inspection Date Inspector. az 1M -6.69-d City of Fridley �'rh ,19 Owner �e_,e4LA Eie,ll Location- _ �/ 2 9 a,A rte , _ Kind of Building_ FAAYvv A_ s Used as To be Completed 219-1-26 Estimated Cost $ % �G-o ®• CrD Old -e Building Permit No. Date Inspector of Buildings. o>ngmal • E MIT for Power Plants and Heatin Cool - P Rg. ing. Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK i No. 5&sa=4 ting Plants to be installed-mitered—repaired Make ��� --- ,size Ltd Q,3 -// b Oil fired_; Coal fired ; Gas tired !!!�; Gas Authorization No. Remarks Approved Final Inspection 4 19_ Inspector Permit N° 4717 Fee $ /r% 00 Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. rMQIJ 1-f , 19 -24 - Owner U F ey 9 tk Location Kind of Bui1d--ng AP -14 M L How Occupied Li F - u- r Al 6 Work to be Commenced—, 19— To be Completed J i c -L-✓ / ,191A Estimated Cost, Qdl New, Building Permit No Permission is hereby granted too install—erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the perso to whom t is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mention shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be don and the operation of the devices herein named, and to the specifications t fo h in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings .11�42 2M 11-67 V Original • • PERMIT for Power Pants and Heating, Cool- ing, Ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of Z Heating Plants to be installed--paltered—repaired Make OJ aAa,42 , Size � 9, •S�-0 Oil fired ; Coal fired—, Gas fired ; Gas Authorization Remarks Approved Final Inspection 19_ Inspector Permit N® 4772 Fee $ M-, U U Office of the Inspector of Buildings City of Fridley City of Fridley, Minn.— aA_, 19-2--Q Owner a2e:V-UJQArV4JatL-- Location 9LslJa�(A Kind of Building,2 How Occupied Work to be Commenced—,19— Approved ommenced ,19_ To be Completed—, 19 Estimated Cost, $ e5V.0-0 Old- ew, Building Permit No. Permission is hereby granted to �2—K-e6L-L- ,641 p �/ �.f� 1� to install—erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specification=> -A the approved application for this permit on file in the office of the Inspector of Buildings. �, Inspector of Buildings z 2M11 -VV SUBJECT PE City of Fridley 28628 AT THE TOP OF THE TWINS BUILDING PERMIT ( .9:� 1 572-36I REC EIPITY CO M LADEVELOPMENT DIV. ®P1 �---° r PROTECTIVE INSPECTION SEC. � NUMBER REV DATE PAGE OF APPROVED BY 1 CITY HALL FRIDLEY 55432 L J` 612-571-3450 et0-Ft5 11/20/98 JOB ADDRESS 467 79th Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt,2,3&4 1 Spring Brook Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Lutz 785-0945 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner d 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 ja REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (35 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2999 $1.50 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 $74.75 Fire SC 3.00 PLAN CHECK FEE TOTAL F 5 S1N RE O� CDN'R CTOR OR AUTNOR�ZEO AGENT iDATEi EN PROP ALIDATED T 1$ IS Y UP PERMIT S-GNOTUR O OW NER0iDATE, Pft"4'ftILOER[ B 0.40ft- g6TE NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R -2 d.), BUILDING PERMIT APPLICATION ConstructionAddress: / — P Legal Description: /� Owner Name &Address: L74L-A Tel. #_7�� Contractor: �� J211 MN LICENSE # Address: Tel. # Attach to this 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: Construction Type: DESCRIPTION OF IMPROVEMENT Width Width /Width Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Estimated Cost $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: — 7O-� APPLICANT: Tel. # 7V�- 4!5) %V.5 CITY USE ONLY Permit Fee $ 7,,/' ,, Fee Schedule on Reverse Side Fire Surcharge $ 3,00 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 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: CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 5431 Uhiversity Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 1w '2q' RATE SCHEDULE OWNER �A �1� l7Z f. . Residential Rate TOTAL Furnace Shell and Duct Work, Burner - T BUILDING USED AS 1JJ 62-1-4 "-J Also Replacement Furnace $ 30.00 (Side Vent' Fill Out Back) $ �p. 0q. (_ ESTIMATED COST PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) ; DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units_ Circle One (Steam) (Hot Water)arm Ai Gas Dryer $ 10.00 $ Trade Name kyt)b Size No. :kre� *Air Conditioning - All Sizes $ 25.00 _ BTU '"'acs® HP EDR Fuel - e_ -As Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value'of Appliance or Work $ BTU HP EDR F_ U. R AJ A -CA-_ RC X04J- - t N Commercial/ Industrial 6*1c- 1.25% of Value of Appliance or Work $ 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 an State Surcharge $ 50 rulings of the Building Division, and hereby declares that all the facts and TOTAL FEE representations stated in this application are true and'coreect. $ SUPERIOR CCNfMG 9:56E, h,,_ 612142,0AVENUENC. DATE CRY MN 55422 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed TEL # FAX #►�� REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date written permission from adjoining property owner. THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VFNT, V NT CQNNFCTQR ANn .OMRl1STION AIR V RIFT CATION When re lacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No (� The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (4 No ( ) The existing cnmhustinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No (� When required to install a new rnmbwstinn airy it will be sized and installed to meet the current codes and manufacturer's specifications. Yes (,j'No When installing a new venting -qv, tom, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes KNo ( Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes (-'No ( ) Appliance #1 Type U u > BTU Input)- F n ssiste r Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type P U G A3 cs k /�z% ov HEATING CO: 3'0A5*l©P- CDAJ7-4 IV C-7-0 k -V Signed By: Date:�— CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-12N7 ADDRESS 467 79TH WAY NE PIN 033024310014 LEGAL DESC SPRING BROOK PARK LOT 2 BLOCK 1 PERMIT NO.: 2004-00271 O / DATE ISSUED: 02/25/2004 ' PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A REPLACE GAS WATER HEATER (AO SMITH, PVGL4-) # ELEC WATER HEATERS 0 # GAS WATER HEATERS 1 # GAS RANGES 0 ENTER VALUATION 800 APPLICANT RIVER CITY SHEET METAL INC 9928 BLUEBIRD ST NW COON RAPIDS, MN 55433 (763) 754-2199 DYATRNUI LUTZ GARY J & SUSAN M 467 79TH WAY NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction 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 worl 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 co ction or the performance of construction. Annlicl, Date Bldg # NEW FIXTURES (EXIST OPENINGS) 0 # GAS DRYERS 0 # OF NEW FIXTURES 0 # WATER TRMT APPLIANCES 0 PLBG PERMIT MINIMUM FEE 20.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 12492 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Q;AY OF FRIDLEY INSPECTION DIV. 3i University Ave NE i1ey, MN 55432 Q :3) 572-3604, FAX (763) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT aaAou wn 1KA0=n ne eivrt iDe@ Tn RC IAICTAI 11=n niU GAr_4J FI r)r)R ff J 1 2 E ec6ve On an 003 ( .UMBING FIXTURE RATES. NO. RATE aw Fixtures id Opening, New Fixture =erDispenser ow Off Basin atch Basin ain Water Leader ump/Receiving Tank later Treating Appliance later Heater -Electric Dater Heater ��� Is/w Sas Dryer" ;ack Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 TOTAL JOB ADDRESS L4 fo? ?� WO, r— P 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. a — i8 Zos Owner -A) LQ r -?-- 10.00 oO Building Used As 140 M E Estimated Cost 6,190-,00 PERMIT NO. Zeinspection Fee $47.0011 -Ir kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance D,o State Surcharge $ .50 TOTAL FEE $ D. PLUMBIC SIGNED Approve( MINIMUM FEE FOR ANY PLUMB1ttitGIGAS PERMIT IS $20.00 PLUS THE 8.60 STATE SURCHARGE :.OMBUSTION Al R SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE Washy a Floor ''lo-oq - t Auto. -['f Gas Water Heater ..3;•'ec-F�,u.. Stones �....•� rf: Urinal x ;_u -::-��; Shower -Frsex';3:. sai :: Tray�.- ., .<.:> Drain ::... .. •Washer -: -.- '-.. Ran e i - __ Gas Etec . ._ id« ... Basement �v$s;•3:4-. A. -. Ky a � ' ... r-. '. xi�cjiixF. �J� F>Pl'�: lu - .... �-•�.e:• .. �T.+,: • rY:� ... ':' i. :`.:: .flX npif _ _ cart „a^. wit`s Floor 1 x a �.... .__..; .. Yx�aa!:�,�c<,.-�>:i Floor 2 'x = ;":"' . <: '°°�':ftiilbi,': :;��ice�...-�lc�;tn>•• ��S�. x"y3'gi a°`aePY:'•°-T+�•..:: A� ,��,ir�„ SoR�.......� •�.�;,;;_.._:::: Floor 3 jS:Y.i>x34: <:ie i ��' ;tea!? , �tf:::• t.. r:`. �eLit '��eT OF xat:?aa':.i y1F'sSR '- :�'-,•a . .i..:.., P`.T`•?'t5?� n... r^ Floor 4 ,�:>�,;��=k�>:: ': Kme<�T", �'- $ ee oaf - •-<. �x .; �.:,. a yC x�'�cx.:: - x-. °"$'y'..,.�,, %?`i4 ..•��� sai%an^}: ti` i'• i e:- � tF. :........ �• x ::xx:_:: �^'i"rY'.�-��: S?�-� .7ig 4.. •a•S. . ,�, .. y`�•`.o`. .�+�'.�.'.�..'v-.. �acL� w `+s^"'''..n:'�"..''r.•X•.-ay?S'.... .UMBING FIXTURE RATES. NO. RATE aw Fixtures id Opening, New Fixture =erDispenser ow Off Basin atch Basin ain Water Leader ump/Receiving Tank later Treating Appliance later Heater -Electric Dater Heater ��� Is/w Sas Dryer" ;ack Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 TOTAL JOB ADDRESS L4 fo? ?� WO, r— P 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. a — i8 Zos Owner -A) LQ r -?-- 10.00 oO Building Used As 140 M E Estimated Cost 6,190-,00 PERMIT NO. Zeinspection Fee $47.0011 -Ir kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance D,o State Surcharge $ .50 TOTAL FEE $ D. PLUMBIC SIGNED Approve( MINIMUM FEE FOR ANY PLUMB1ttitGIGAS PERMIT IS $20.00 PLUS THE 8.60 STATE SURCHARGE :.OMBUSTION Al R SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE