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�� <br /> .AL%n! <br /> COMMUNITY DEVELOPMENT DEPARTMENT PHONE: 651-490-2238■ FAX 651-490-2931 <br /> ESID�II�TIAL BUILDING PERMT APPLICA <br /> PERMIT NUMBER _ - <br /> ❑ New ;�'`, Alt ration ❑ Addition ❑Garage <br /> WORK PROPOSED: Deck �OtSiding Grading (see supplement) ❑ Demolition <br /> f <br /> ❑ Window ❑ Draintile Other: AEQGkF <br /> APPLICATION DATE: -A <br /> address: - YIN Number (Optional): <br /> SITE: S 0 A-0(A PWE5 <br /> Lot ptian ::.f r� � B o on <br /> Subdivision opt' <br /> ;. <br /> I Ph <br /> APPLI CA T: a ' one: _ - <br /> A ens _�• � �• �� _ <br /> ',,-.,Name: Phone: <br /> 0 1 -7;(,,&�;) <br /> WNIER. 4 B C6 <br /> Address: <br /> CONTRACTOR: Nam Pane: <br /> Address � � � �cense lNum r: <br /> VALUATION labor & materials): $ �-�`*� �"`�" 61 <br /> WORK DESCRIPTiON: Uja_ob <br /> (0� <br /> r4 ` L <br /> STRUCTURE TYPE: ❑Sin FlNwdi <br /> ttached Single Family Detached ❑other: <br /> .-I_ <br /> ,e ,; Sri - Basement: <br /> INDICATE SQUARE ad ;� � - Porch: <br /> 2 floor: Carage: <br /> FOOTAGE OF: �� ]�l #of Stories: <br /> ..LL■ <br /> Acknowledgement and Signature: <br /> The undersigned hereby makes applicatio' 'torthe Ci v ioseville to perform the work as herein described.The undersigned further states,under penalty of <br /> law,that the work will be performed in accordance with the Minnesota State Building Code,this application,and any approved plans and/or specifications. <br /> Print Name: Signature: <br /> VV <br /> Contractor Owner Architect Phone: <br /> Date ca . <br /> SEPARATE PERMITS REQUIRED: ❑Electrical ❑ Mechanical ❑ Plumbing ❑ Water Sewer <br /> FEES: 1•0 Water Meter(# } $ <br /> Permit $ j f 2 Construction Deposit Q_- <br /> �L <br /> State Surcharge $ Contractor's License�,� ,� $ X <br /> Plan Check $ Assessments $ <br /> Cert.of Occup. $ Park Dedication $ i <br /> Metro SAC $ Other: $ <br /> WARNING: Be sure to contact public utilities for location of underground cables„ Total Fees:-, <br /> conduits, pipes, etc. before digging. Receipt #: _ <br /> Call Gopher State One: 651-454-0002 Receipt Date: <br />