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R.~ Building Application 2660 Civic Center Drive . RaseYIII_, MN 55113 Planning File No. Date Applied For 1- ICf-'l2.. Building Name City ARCHITECTS: City ~ ~ De8cription of Work £ State ~t\J 1 J~ 1\\.',.... ~.~cO Front SET BACK (In teet) : Floor Area - Square Feet Stori.. Starting Date Comments Phone: (612)490-2238 J r~st,~' ........". ...... ...... ..... .................. ..................... ................. ::::;:::;:;:::::::::::::::;:::;:::;:;:;:;:;: ..:.:.:.::;~::::.:.:.:...:............................,........... ,"... ."............................ ...... ........................................... ····························WARN·I·NG..················............. .. ¡~llltll'11 Acknowledgement and Signature: The undersigned hereby male.. application to the City of Roseville to perform the work .. herein deecribed. The undersigned further åtM, under penalty of law, that the work will be performed in accordance with the Minnesota Uniform Building Code, thla application, and the tubrnltted plant an r tpeclficati . II - I 9' -"2.. Date For Office Use Only .... ..... ..... ....-.................'...........'.;.:.:.:.:.....;.:.:-:';':-:':':':-:':':-:';';':':':':':':';':':':':':';'.':':':':'"," . ". ". ........... Other: $ Total $ Receipt No. Receipt Date APPROVAL: Zoning Building Inspector Fire Marshal Engineering Health Other: FEES: Permit $ <- ~t/. D 0 Plan Check $ ~ State Surcharge ('( r'1 JL $ Metro Sac V' Y tc} J..- 11 $ , Certificate of Occüpancy $ . Contractor's Ucense $ Water Meter C vJ,i * $ Permit Deposit $ Construction Deposit $ Street Deposit $ Assessments: $ $ C;,e:, . ~( ) \ \ \.