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2009 <br />l�� <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 �Residentia� only> <br />❑ Driveway ❑ Shed ❑ Other <br />PROPERTY TYPE: ❑ Commercial ❑ Residential <br />APPLICATION DATE: <br />SITE : A ress: PIN Num er pt�ona : <br />ot pUona : oc pt�ona : u rvision ptiona : <br />APPLICANT: Name: P one: <br />A ress: <br />OWNER: Name: P one: <br />A ress: <br />CONTRACTOR: Name: P one: <br />A ress: icense Num 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: . 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 />Signature: E-Mail Address: <br />Fee Calculation: <br />Draintile: $104.00 <br />Driveway: $ 44.00 <br />Fence: $ 78.00 <br />Shed: $ 63.00 <br />Swimming Pool: $188.00 <br />(Residential only) <br />Fees: <br />Permit $ Contractor's License $ <br />Other: $ <br />WARNING: Be sure to contact public utilities for location of underground cables, Total Fees: $ <br />conduits, pipe� �c. before digging. F-^�'elpt #: <br />Call Gopher Sta. Jne: 651-454-0002 i__:.eipt Date: <br />