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<br />R.~ Building Application <br /> <br />2660 Civic Center Drive . Roseville, MN 55113 <br /> <br />Phone: (612)490-2238 <br /> <br /> <br />PIN No. <br /> <br />Permit No, <br /> <br />Occupancy Type <br /> <br />Starting Date <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 <br />~ions. <br /> <br />":"." :":"::::::);:t::.:;:\:::::::>{)/" <br /> <br /> <br />f?--/~'" 90 <br />Date <br /> <br />FEES: <br />Permit <br />Plan Check <br />State Surcharge <br />Metro Sac <br />Certificate of Occupancy <br />Contractor's License <br />Water Meter <br />Permit Deposit <br />Construction Deposit <br />Street Deposit <br />Assessments: <br /> <br />For Office Use Only <br />Other: <br /> <br />$ <br />Total $ <br /> <br />ffl JJS- <br />I} ~l~ -;/ <br />1(1/ <br />, <br /> <br />$~ <br />$ JI,t:J,r <br />$ ...(~() <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />Receipt No. <br />Receipt Date <br /> <br />APPROVAL: <br />Zoning <br />Building Inspector C\ ~ <br />Fire Marshal <br />Engineering <br />Health <br />Other: <br />