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/ V . <br /> . . l� . <br /> r t <br /> �a�l Fee: $ �-�L��. - Dat�R�Cc��ed: � <br /> � L�ntered Hy: _ �,�=�r:� Permi�t#: _ ,� _ - ��"�;� <br /> �, �i�� r�. � ,,^'r' � • <br /> , �IT�I OF OROlrTC) -BUILDING PERMIT AI'PLICATTON <br /> � , AI�1n�orma�tlon mu�t be submitted in Pull before plan revlew will be �tarted. <br /> ,, <br /> �. (please print a�l�►�forma��on)' . <br /> • .....__�_�.�....._�__�_�._......__._...�..�....._...�___....._��_ _ ._��. ._.___ � . <br /> ��LPPLICAN'1' IS: (circle one) O�iVN�R 0 T � <br /> • • . - , , <br /> -- JOB SITE ADbRT3S: � ZIp: ��"?ZqJ "�• � . <br /> -, N� o� own�x: �rvo.ric.0 �f' ��1 � �o►rr�: (�) ����y�-1•����o <br /> MAILII�iG AD�RESS: �'� c1TY �work) <br /> : a�e:�s <br /> . � . , .,� .. <br /> . � �-; ; � <br /> RenecvalByA,ndereen ��z% ;�'�, "���� <br /> � CONTRACTOR: ' � <br /> • ���AC�p���: � 35Q-73rd Ave.NE ��� ;`� ' <br /> ,�,, , <br /> Fridley,MN 55432 <br /> � � ��+�G��Q���% 763-502-4777 r�C-,�� Z�: <br /> 6"rA�."� LICENSI�: A� �Mrr2o�3o9s3 . ,, <br /> , A�tC�i1TECT/ENGIlVI�R: PHONE: � <br /> Ni.�A3LING ADDRESB: CiTY: � Z�: ' � <br /> ______� <br /> NAM�: �GISTRATION� <br /> TYF� OF 'WURK: New Add"uion Acce�sory Shvcpite <br /> � Move Remodel/Altecation Land Alteration � �� <br /> � <br /> YROI'OS�:U�VQRK(desc�be in detai�: � <br /> , . <br /> � - <br /> STO�S: � � . SQ.P'BBT OF EACA FLOOR: � • <br /> 1+iT0. OF BEY?BOOMS: GA�AGE STAi.I.d5: ATT. DET.. , <br /> , � � <br /> ES'1`IlVIA,T�D CaNSTRUCTION VA1.UA1'ION(earcludMg lenrn: $ � -' �'� � <br /> I ber�by apgly for a 1iu11ding permit and I acknuwledge t4at the information above is complete afld <br /> aceurabe; t�t tl�e work will be ln confau�aan�x�widti the ordlnances and�s of the Ciry a�c1 with <br /> ' the Stata Buildjng Cod�; that I undereta�a�d thi� u not �permi�and work is not to start widw�ut e . <br /> . � permit; and that tbe..work wil� be ln accorda�ec� wlth die.�pprovrd plan. . . <br /> �kP'P'LICANT'3 STGNATUR�: DrATF,i = (/V�Q • � <br /> � 11�OT,E1 Pm�ad� of H��ev�,�ta r�eq�lre aepanote pe�m�t�pproval by Padice Depart�nt mid <br /> Ctty Co�cncll BO da�y�p�ior�o!he eve►tt. NQn-,prrniiet�d�veRta waR no!be ol7owsd. <br /> £/Z ' dP�o� l�0 ' oN�^� �A^ �� ���3S lIW�3d �N1a11 �9 S3N0�-a3013h ��Wdti£ � Ol��l00Z ' ZZ ' ��� <br />