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<br />R.~ Building Application <br /> <br />\/ <br /> <br />Phone: (612)49O-2238 <br /> <br /> <br />2660 Civic Center Drive . Roseville, MN 55113 <br />PIN No. C3;,IQ -JJ -I) - eee'7 <br /> <br />Permit No. .11 q / - 7!J- 8 <br />Site Address <br />g- <br /> <br />"/2 y;/I.-I.. <br />Name ¡¿ /, <br />City g <br />h dr" ~: ~u; <br />ARCHITEcrS: Name <br /> <br />. /.... q"\ r <br />Telephone No. <br />t <br /> <br />'^ L..H( <br /> <br /> <br />" <br /> <br />City <br /> <br /> <br />Telephone No. <br /> <br />Description <br /> <br /> <br />SIde <br /> <br />/ l( I <br /> <br />Side <br /> <br />3~ / <br /> <br />SET BACK (in feet) : <br /> <br />Starting Date <br /> <br />7/ <br /> <br />Comments <br /> <br />ç-{, , ðð <br /> <br />Acknowledgement and Signature: <br />The wnderIignecI h«eby makes application to !he City of RosevIIIe to perform !he work . herein <br />described. The undersigned fur1her S1at8S. under pINIIty or law, 1hat 1he work wi be perfofmed in <br />accordance with !he Mnnesota U . Building e, !his appic:ation, ancIlhe submillld plans and! <br />or . 'ons' . <br /> ~ 7 <br />v !?-~7-9/ <br />Dale <br /> <br /> <br />. ,,' . ,.. <br />,"'.. ..."--' .. <br />WARNING ,." ,", <br />Be, surelôcolÏtaCf,·public utilitie~··for:.~ <br />,'location of undergroünd ,., cables"coo+:=: <br />duits. pipes; etc. before digging.i 'q'q.. <br />" CaUGopher StateOne-;CaU q <br />q'" '<454-0002 <br /> <br /> <br /> <br />For Office Use Only <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: $ :: .- u . <br /> .., i <br />$ ." ~. ....¡,.. ' . ; Total $ j"-"" ' , . - <br />$ /~·O(.; #: ì 4l:Ù <br />$ ,. .' Receipt No. <br />t ~J .~.' Receipt Date q¡Cj{ll <br />$ t".. <br />$ } / APPROVAL: ~ <br />$ - .. Zoning <br />$ r·~ l Building Inspector <br />$ j ~ Fife Marshal =iK <br /> . . <br />$ oµjk-- Engineering <br />$ Health <br />$ Other: <br />