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<br />/ <br /> <br />R.~ Building Application <br /> <br /> <br />2660 Civic Center Drive · Roseville, MN 55113 <br />PIN N°'1 0;11 -) '3 -;) '3 - Óð 3::J <br />'3 <br />.-...~S-;+ A'-J{?- <br />NT< of> e v," -r ft." <br /> <br />Phone: (612), <br /> <br /> <br />Planning File No. <br /> <br />Pennit No. <br /> <br />Construction Type <br /> <br />Occupancy Type <br /> <br />Ave <br /> <br />City <br /> <br />State <br /> <br />Description <br /> <br /> <br />G?-i-, ~ 5T ì Yt <br /> <br />Do^- ; ~ "'^ <br /> <br />ClI""; L""~ ~e_ <br /> <br />Front <br /> <br /> <br />Back <br /> <br />Side <br /> <br /> <br />SET BACK (in feet) : <br />Floor Area - Square Feet <br /> <br />Starting Date <br /> <br /> <br />~ <br /> <br />Finishing Date <br /> <br />Comments <br /> <br />Acknowledgement and Signature: <br /> <br />The undersigned hereby makes application to the City of Roseville to perform the work as herein <br />described. The undersigned further states, under penalty of law, that the work will be performed in <br />accordance with the Minnesota Uniform Building Code, this application, and the submitted plans and! <br /> <br />or7Y~ ßt; 7·- / ì- 9 '- <br /> <br />/ A~icant Signature Date <br /> <br />",.---- ... ....-_. "',...-.-_....... --....,.-.... ... .. "-""',""" <br />..C.' '_:-",'.'.'':'::.':-: »>::.::.:.:;::::.:.::::::_:_:::::::<;;;. :;:'»:-:-:-:::::':':':::,-:-:-:-:-.-:-"'>.-:-:-::'-:::.'.:::-:-:-::-:;;;.:-:::-::::;,:::.:::;::::::: <br />:::::-:':-:'::'::;.":::-::-:-:-:':-:-:':','::':::::-:-:::;;':':':':;;':-:-:;-::-:-:-:-:-:<->:':':-:':'-:-:-.':-:':-:.-<:.-:,.:-,-:.:.-.-:-:>::-:'.<...,:-::.-<.:-:........-:. <br />>W·'·A·""R'·····'N··"I·'N···'G < <br />.-.--._:::<_:<:::::::>::::::::::::::::::::::::::::::::.::::::/:::::. - - .. - -- ,.,,' .:.:.::::::::<:::::::>:-::::.:::-:>::::::::::::::-:::::<:::::::::.:::: <br /> <br />ße s(jre tô êc)tltâçtÞµbHC, ûtilitie$]Q' <br /> <br />;ilê(ti!¡,frìlll, <br /> <br /> For Office Use Only <br />FEES: Other: $ <br />Permit $ b <. .0 Ò Total $ 7ð. (to <br />State Surcharge : ~ . (~ 0 Receipt No. ~~fiI1J- <br />Plan Check <br />Metro Sac $=ft Receipt Date <br />Certificate of Occupancy t. $ . APPROVAL: <br />Contractor's License 5t~ ~ $ S,ð( Zoning <br />Water Meter $ N..L Building Inspector <br />Construction Deposit $ ,J/J. Fire Marshal <br />Street Deposit $ ð( \!l::- Engineering <br />Assessments: $ Health \ <br /> $ Other: \ <br /> <br />