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2009 <br />1�� <br />� <br />COM�1l!NI'1�1� DGVEIAP�M1iF:�'"� UEPrVt�l:�ll�;N'1�. PHONE: 651-792-7080. FAX: 651-792-7U70 <br />2GG0 CI��IC ('G'�"I�ER DR. • ROSE�'ILLE, M1 55113 <br />PROPER TY IMPROVEMENT PERMIT APPLICA TION <br />PERMIT NUMBER: <br />WORK PROPOSED: ❑ Draintile ❑ Fence ❑ S���imming Pool �R�.�de�u�� �„i� � <br />❑ Driveway ❑ Shed ❑ Other <br />PROPER�TY TYPE: ❑ Commercial ❑ Residential <br />APPLICA"i�ION DATE: <br />S[TE : A ress: PIN Num er (Optiona ): <br />ot ( ptiona ): oc ptiona ): u ivision ptiona : <br />APPLICANT: �ame: P one: <br />A ress: <br />OWNER: '`Iame: P one: <br />A ress: <br />CONTRACTOR: Name: P one: <br />A ress: icense : 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 yai°d (abutting a street). <br />FOOTAGE OF: — <br />• Swimming pool installations. <br />Acknowledgement and Signature: <br />I�he undersigned hereby makes application to the City of Roseville lo perform the work as herein descrbed. "I�he uncJersigned further states under penalt�� 01� <br />la���. that Uie �+�ork �+�ill be performed in aocordance with the Minnesota S[ate Building Code. this application and any approved plans and/or specifications. <br />Print Name: Phone: Date: <br />❑ C'ontractor ❑ Owner ❑ Architect <br />Signature: E-Mail Address: <br />• <br />Fee Calculation: <br />Uraintile: $104.00 <br />Driveway: $ 44.00 <br />F� ence: $ 78.00 <br />Shed: $ 63.00 <br />S���imming Pool: $188.00 <br />(Kcsidcntial only) <br />Fees: <br />Peri��it $ Contractor's License $ <br />Other: $ <br />WARNING: Be s�u�e to contact public utilities for location of under�roui�d cables, Total Fees: � <br />conduits, pipes, e�c. before digbin�. Re�eipt #: <br />Call Gopher Statc .�e: 651-454-0002 R, ipt Date: <br />