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2009 1�, <br />('O.�1111 .\Ill UF:� ELOPIIF:\7 UI:P \Il l�ll'\7 . PHO\E: 651-792-7080 � FAX: fiSl-79?-7070 <br />2GG0 ('1� 1(' (1:\'"fER DK.. ROSE�'11.1.E, 111' SSI 13 <br />PROPERTY IMPRO IJEMENT PERMI T APPLICA TION <br />PERMIT NUMBER: <br />Vl'ORK PROPOSED <br />PROPER"I�Y TYPE: <br />APPLICA7�ION DATE: <br />SITE : 4 ress: <br />ot ( ptiona : <br />APPL[CANT: �vame: <br />A ress: <br />OWNER: i ;vame: <br />A ress: <br />CONTRACTOR: �vame: <br />A ress: <br />❑ Draintile <br />❑ Drive�vay <br />❑ Commercial <br />onal 1: <br />VALUA��ION (labor & materials): $ <br />WORK DF.SCRIPTION: <br />INDICATE <br />SQUARE <br />FOOTAGE OF: <br />❑ Fence <br />❑ Shed <br />❑ Residential <br />❑ Swimming Pool ��tcside�,ua� uni�� <br />❑ Other <br />��vumner (uptionai ): <br />u ivision ption� <br />one: <br />none: <br />icense . um <br />Note: Site plan and review required for: <br />� Drivew�ays within 5 feet of side property lines. <br />Shed: <br />• Fences abutting lakes. <br />• Fences over 4 feet and in a tront yard (abutting a street). <br />• Swimming pool installations. <br />Acknowledgement and Signature: <br />fhe undersigned hereb�� makes application to the Cit�� of Roseville to perfonn the work as herein descrbed. �I�he undersigned further states under penz�lt�� 01 <br />la��, that the ��orh �vill be perfi�rmed in aocordance �� ith the Minnesota State Building Code, this application and any approved plans and/or specifications. <br />Print Name: Phone: Date: <br />❑ Contractor ❑ O���nrr ❑ Architect <br />Signature: <br />Fee Calculation: <br />Draintile: <br />Drivewav: <br />Fence: <br />Sl�ed: <br />Swimming Pool: <br />(Residcntial onl��) <br />Fees: <br />$104.00 <br />$ 44.00 <br />$ 78.00 <br />$ 63.00 <br />$188.00 <br />E-Mail Address: <br />Permit $ Contractor's License $ <br />Other: $ <br />WARNING: Be sure to contact public utilities for location of underground cables. Total Fees: $ <br />conduits, pipes, e^ before digging. R�1pt #: <br />Call Gopher Stat ne: 651-454-0002 R,ipt Date: <br />