Laserfiche WebLink
<br />~~ <br /> <br />R.~ Building Application <br /> <br /> <br />2660 Civic Center Drive . Rosev.lII e, MN 55113 <br /> <br />IPI~~ !\do. <br /> <br /> <br />Planning File No. <br /> <br />Permit No. <br /> <br />D.. A,pp.Ue>t! fo<< <br /> <br />Building Name <br /> <br /> <br />, <br />I <br /> <br />OWNER'S: <br />, <br />city 0 ' <br />I~"s.tl..llll l-t <br />BUILDERS: <br /> <br />City <br /> <br />SET BACK (In f..f) : <br /> <br />Front <br /> <br /> <br />Floor Area - Square. Feet <br /> <br />Starting Date <br />C <br /> <br />CommentIJ <br /> <br /> <br />State <br />fV\IV' <br /> <br />c;,. 0 . <br />State <br />M ,'V <br /> <br />State <br /> <br />Telephone No. <br /> <br />Back <br /> <br />Side <br /> <br />Finishing Date $;1 <br />1- <br /> <br />Acknowledgement and Signature: <br />The undersigned hereby makes application to the City of Rossvrne to perform the WOfk 88 herein <br />described. The undersigned further etates, under penalty of law, that the work will be performed in <br />accord with the Mlnnesota;Uniform Building Code, this application, and the submitted plana <br />and/or p cations. . ~f'to'" I ,), C ~ .) I( . <br /> <br />(iJ- >-}r -<? '-- <br />Date <br /> <br /> <br />FEES: <br />Permit <br />Plan Check <br />State Surcharge <br />Metro Sac <br />Certificate of Occupancy _..l <br />Contractor's Ucense S~c\)\ ~ r1 <br />Water Meter i11 d 6') <br />Permit Deposit <br />Construction Deposit <br />Street Deposit <br />Assessments: <br /> <br />For Office Use Only <br /> <br />Other: <br /> <br />$ <br />Total $ <br /> <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />/53.00 <br />,. <br /> <br />Receipt No. <br />Receipt Date <br /> <br />,.a6 <br />'" <br />" <br />5'. (1() <br /> <br />APPROVAL: <br />Zoning <br />Building Inspector <br />Fire Marshal <br />Engineering <br />.Health <br />Other: <br /> <br /> <br />Side <br /> <br />I ~ S.~ 0 <br /> <br />. <br />"'f"J6 ~ <br />16/:t'i q <br /> <br />