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<br />~~ <br /> <br />Building Application <br /> <br />Community Development Department. 2660 Civic Center Drive. Roseville, MN 55113. Phone: 612.490.2238 · FAX: 612.490.2931 <br />fOR OFFICE USE 9NL Y: PIN No.' " .;", , " ' . PJ;jflnin(File~~;' ..: .~' '. .. ' .. <br /> <br /> <br />Permit No. <br /> <br />Date of Permit <br /> <br />. 'Tenant Name <br /> <br />SITE: <br /> <br />OWNER: <br /> <br />w k.e ~1'~1- ~+. N <br />Telephone No, <br />4-75vg} <br /> <br /> <br />Cily <br />7v ... ~.st <br /> <br />ARCHITECT: <br /> <br />City <br /> <br />State <br /> <br />Zip Code <br /> <br />DESCRIPTION OF WORK BEING DONE: <br /> <br />SETBACK (in feet): <br /> <br />Front <br /> <br />~ I v5t>~ <br />Side <br /> <br />Starting DaTc <br /> <br />COMMENTS: <br /> <br />~ <br /> <br />ce-J ~'\. ~ <br /> <br />PLEASE NOTE' Electrical, plurf!bing, ~eating, fire sprinkler and alarm each require a separate permit. To obtain a permit application on the Internet: <br />, http://www.a.roseVllle.mn.us <br /> <br />Acknowledgement and Signature: <br /> <br />The undersigned hereby makes application to the City of Roseville to perfoTm the work as herein <br />described. The undersigned further slates, 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 and! <br /> <br /> <br />=P~~~ uNqr D", <br /> <br /> <br />-I'.. <br /> <br />..: ~. <br /> <br />'. Office Use Only'.' <br /> <br />. . <br /> <br /> <br />Total ~ees <br />,: <br />,',.:.:, Receip,t N~: <br /> <br />Receipf~irte <br />" , <br /> <br /> APPROVAL: <br />$ Fire Marshal <br />$ E ngi neeri n g <br />,$ Zoning <br />$ Plan Reviewer <br />$ Other: <br />$ <br /> <br />Permit <br /> <br />; $. <br /> <br />- <br /> <br />.... "FEES(cont.): <br />Streei Deposil <br />'Sewer &.Waier <br />, Assessments <br /> <br />FEES: <br /> <br />.;:-. I~~' . <br /> <br />",. ~ ~ <br /> <br />Stale Surcharge <br /> <br />" <br /> <br />$. <br /> <br />, ~c-:~ /.-:, <br /> <br />". <br /> <br />Plan Check' $ <br />Certificate of Occupancy . $ <br /> <br />Metro SAC <br /> <br />$ <br />$-. <br />$ <br /> <br />- ,- <br /> <br />Water Meter <br /> <br />.~ <br /> <br />Construction.DepC?* '; <br />C-'''-:-'-:-."~ . ". ' <br />c:q,~,tracto r' s li cense . <br /> <br />, . <br /> <br />-- <br /> <br />- .. <br /> <br />.: <br /> <br />'1- <br />