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<br /> <br />R.~ Building Application <br /> <br />2660 Civic Center Drive · Roseville, MN 55113 <br />PIN No. 03:;1-)'3 - {J - ðCû7 <br />Permit No. Aq 1- 75 >J <br />Site Address <br />8- <br /> <br />"Il v¡ll..e. <br />Name E <br /> <br />City 0 <br />~hor~ ,.......¡ <br />Name <br />ARCHITECTS: <br /> <br /><2-- u... <br /> <br />City <br /> <br /> <br />Telephone No. <br /> <br />Description <br /> <br /> <br />Side <br /> <br />/if' <br /> <br />SET BACK (in feet) : <br /> <br />Starting Date <br /> <br />Declared Value of this Project <br />-::5¿J 01"- <br />Finishing Date 11_ /"... 7' I <br /> <br />Comments <br /> <br />ç-c,~. 6S <br /> <br />J <br /> <br />Phone: (612)490-2238 <br /> <br />Lelt:H( <br /> <br />~ // g 4f <br /> <br />Side <br /> <br />.3c; / <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 Unifor Building e, this application, ànd the submitted plans andl <br />orsp .. ti?:: <br /> <br />¡lllljlllll!; <br /> <br /> <br />.. .............-............... . .... . <br />. ............. . <br /> <br /> <br />//-;;17--9/ <br /> <br />Date <br /> <br />For Office Use Only <br /> <br />$ d. '>:L/,S7) <br />$ I <), 0 u <br />$ N f) <br />$ /\J~ <br />$ ~) <br />$ d~'ÙÙ <br />$ NA <br />$ 10/\ <br />:~ <br />$ <br /> <br />$ <br />Total $ :$ d l/, S 0 <br />#: / </KO <br />91 q {1l <br />~ <br /> <br />=;t <br />'" <br />\ <br />, <br /> <br />FEES: <br />Permit <br />State Surcharge <br />Plan Check <br />Metro Sac <br />Certificate of Occupancy <br />Contractor's License <br />Water Meter <br />Construction Deposit <br />Street Deposit <br />Assessments: <br /> <br />Other: <br /> <br />Receipt No. <br />Receipt Date <br /> <br />APPROVAL: <br />Zoning <br />Building Inspector <br />Fire Marshal <br />Engineering <br />Health <br />Other: <br />