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2009 <br />1�� <br />� <br />COMMUNITY DEVELOPMENT DEPARTMENT � PHONE: 651-792-7080 • FAX: 651-792-7070 <br />2660 CIVIC CENTER DR. � ROSEVILLE, MN 55113 <br />PROPERTY IMPROVEMENT PERMIT APPLICATION <br />PERMIT NUMBER: <br />WORK PROPOSED: ❑ Draintile ❑ Fence ❑ Swimming Pool (Residential only) <br />❑ Driveway ❑ Shed ❑ Other <br />PROPERTY TYPE: ❑ Commercial ❑ Residential <br />APPLICATION DATE: <br />SITE : A ress: N Num er ptiona : <br />ot ptiona : oc ptiona : u rvision pUona : <br />APPLICANT: ame: one: <br />ress: <br />OWNER: ame: P one: <br />ress: <br />CONTRACTOR: Name: one: <br />ress: �cense um er: <br />VALUATION (labor & materials): $ <br />WORK DESCRIPTION: <br />Note: Site plan and review required for: <br />• Driveways within 5 feet of side property lines. <br />INDICATE • Fences abutting lakes. <br />SQUARE Shed: . Fences over 4 feet and in a front yard (abutting a street). <br />FOOTAGE OF: <br />• Swimming pool installations. <br />Acknowledgement and Signature: <br />The undersigned hereby makes application to the City of Roseville 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: Phone: Date: <br />❑ Contractor ❑ Owner ❑ Architect <br />Si�naturc� F,-'�-lail .���lcli-e�s: <br />• <br />H�cc Calculatiuu: <br />Draintile: $ ] 04.00 <br />Driveway: $ 44.00 <br />Fence: $ 78.00 <br />Shed: $ 63.00 <br />Swimming Pool: $188.00 <br />(Residential only) <br />Fees: <br />Perrnit $ Contractor's License $ <br />Other: $ <br />WARNING: Be sure to contact public utilities for location of underground cables, Total Fees: $ <br />conduits, pipes before digging. �1pt #: <br />Call Gopher Sta�ne: 651-454-0002 I�eipt Date: <br />