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<br /> <br />jjltfll D.~~ <br />.I.~ BLJ <br /> <br />Post-it'" Fax Note 7671 <br /> <br />~ <br /> <br /> <br />/ <br /> <br />2660 Civic Center Drive · Roseville, MN 55113 <br />PIN No. <br /> <br />Phone # <br /> <br />Phone # <br /> <br />Fax # <br /> <br />Fax # <br /> <br />Permit No. <br /> <br />City <br /> <br />ARCHITEcrs: <br />City <br /> <br />Name <br /> <br />SET BACK (in feet) : <br /> <br />Starting Date <br /> <br />Comments <br /> <br />A ¡- <br />AS <br /> <br />Acknowledgeme 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, un er penalty of law, that the work will be performed in <br />accordance with the Mi esota Uniform Build' g Code, this application, and the submitted plans andJ <br />or s 'fi ons. <br /> <br />yj/£Ø <br />Date <br /> <br />WARNING <br />Be sure to contact public utilities for <br />location of underground cables, con- <br />duits, pipes, etc. before digging. <br />Call Gopher State One-Call <br />454-0002 <br /> <br /> <br />For Office Use Only <br /> <br />FEES: Other: $ <br />Permit $ 1'35, öð Total $ <br />State Surcharge $ G.OD Receipt No. <br />Plan Check $ <br />Metro Sac $ Receipt Date <br />Certificate of Occupancy $ APPROVAL: <br />Contractor's license $ Zoning <br />Water Meter $ Building Inspector <br />Construction Deposit $ Fire Marshal <br />Street Deposit $ Engineering <br />Assessments: $ Health <br /> $ Other: <br /> <br />