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Za09 1' i <br />(�0:�1'111�.A1�1�1 D1�:�'ELOP111�:A7 U1�_I'-Utl��lEV'"I�. P110\E: G�1-792-7080 • FAX: 651-7)2-7070 <br />2660 CI���1C CEV�TER DR. • ROSE�'1LLI�;, ,�91 55113 <br />PROPERTY IMPROVEMENT PERMI T APPLICA TION <br />PERIVIIT NUMBER: <br />W'ORK PROPOSED: ❑ Draintile ❑ Fence ❑ Swirnmin� Pool �Etc,�d��,ud� u„�� i <br />❑ Driveway ❑ Shed ❑ Other <br />PROPERTY TYPE: 0 Commercial ❑ Kesidential <br />APPLICA"i�ION DATE: <br />SITE : A ress: PiN Nwn er (Optiona ): <br />�ot ( ptiona ): oc ( ptiona : u iv�sion ( pUOna : <br />APPLICANT: '`�ame: P one: <br />A ress: <br />O��'NER: �`ame: P one: <br />A ress: - <br />CON"IRAC��OR: Name: P ione: <br />A ress: - icense �um er: <br />VALUATION (labor & materials): $ <br />WORK DESCRIPTtON: <br />Note: Site plan and review required for: <br />• Driveways within 5 feet of side property lines. <br />WDICATE . Fences abutting lakes. <br />SQUARE Shed:__ . Fences over 4 feet and in a front yard (abutting a street). <br />F007 AGE OF: — <br />• Swimming pool installations. <br />Acknowledgement and Signature: <br />fhe undersigned hereby makes application to t6e Cit�� of Rose�� ille to perforni die work as herein descrbed. The unelersigned further states under penalt�� of <br />la���, that the �+�ork �� ill be performed in accordance ���ith the Minuesota State Building Code. this application and any approved plans and/or specifications. <br />P�•int Name: Phone: Date: <br />❑ Contractor ❑ O���ner ❑ Architect <br />Signature: E-Mail Address: <br />• • <br />Fee Calculation: <br />Draintile: $ ] 04.00 <br />Driveway: $ 44.00 <br />Fence: $ 78.00 <br />Shed: $ 63.00 <br />Swimming Pool: $188.00 <br />(Itesidential onlc) <br />Fees: <br />Permit $ Contractor's License $ <br />Other: $ <br />WARNING: Be sw�e to contact public utilities for location of underground cables, Total Fees: $ <br />conduits, pipes, e�, before digging. RP-�eipt #: <br />Call Gopher Stat� .�e: 651-454-0002 R. ,ipt Date: <br />