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~SIMbbE Building Application ~-ll ~ Community Development Department. 2660 Civic Center Drive. Roseville, MN 55113. Phone: 612.490.2238 . FAX: 612.490.2931 FOR OFFICE USE ONLY: PIN No. Planning File No. Permit No. Date of Permit SITE: Tenant Name 8\- City State License No. ARCHITECT: City State DESCRIPTION OF WORK BEING DONE: 0ocl\ COST OF PROJECT (labor & materials); ~ 700" Ci) s~ S~ PLEASE NO rE' Electrical, plu,,!bing, ~eat;ng, fire sprinkler and alarm each require a separate permit. To obtain a permit application on the Internet: . hllp: II www.cuosevllle.mn.us Acknowledgement and Signature: The undersigned hereby makes application to the City of Roseville to perform the work as herein described. The undersigned further states, under penalty of law. that the work will be performed in accordance with the Minnesota Uniform Building Code, this application, and the submilCed plans and! or sp cifications. -$.::J \--qf3 Date WARNING Be sure to contact public utilities for loca- tion of underground cables, conduits, pipes, ete. before digging. Call Gopher State One-Call 454-0002 FEES: Permit $ State Surcharge $ Plan Check $ Certificate of Occupancy $ Water Meter $ Metro SAC $ Construction Deposit $ Contractor's License $ Office Use Only FEES (cont.): APPROVAL: $ Fire Marshal $ Engineering $ Zoning $ Plan Reviewer $ Other: $ Street Deposit Sewer & Water Assessments Total Fees Receipt No. Receipt Date