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<br />.?....... <br /> <br />......... , <br /> <br />~'- <br /> <br />, '~ <br /> <br />/'i~ <br /> <br />'.. <br /> <br />~SI3VfbbE <br /> <br /> <br />. <br /> <br />Building Application <br /> <br />~-l\ -lif <br /> <br />Community Development Department · 2660 Civic Center Drive~. Rosevitle, MN 55113 · Phone: 612.490.2238 · fAX: 612.490.2931 <br /> <br />FOR OFFICE USE ONlY: <br /> <br />PIN No. <br /> <br />Planning File No, <br /> <br /> <br />Permit No. <br /> <br />Date of Permit <br /> <br />Tenant Name <br /> <br />SITE: <br /> <br />.e. ~T <br /> <br />City <br /> <br />State License No, <br /> <br />ARCHITECT: <br /> <br />'" <br /> <br />City <br /> <br />State <br /> <br />Telephone No. <br /> <br />DESCRIPTION OF WORK BEING DONE: <br /> <br />Stories <br /> <br /> <br />Side <br /> <br />Side <br /> <br /> <br />COST OF PROJECT (labor & materials); ~ '7000 Cf() <br /> <br />...... <br /> <br />/", \ I 1'... ~-, ^ 'j ,) i ' <br />\ ,-", '..y ,j\1 '~..... I <br /> <br />I; ""'- <br />\ j ',i.. L. <br /> <br />PLEASE NO TE: Electrical, plumbing, heating, fire sprinKler and alarm each require a sepatate permit. To optain a permit application on the Internet: <br />http://www.ci.roseville.mn.us..~.-o~\~..I.f 1..1 <br /> <br />r , I <br /> <br />Acknowledgement and S~~n,a,ure:, ~ ' ,":' , :.. L - ~I <br />The undersigned hereby makes application 10 the City of Roseville 10 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 Ihe submitted plans and! <br />or specifications. <br /> <br />~^ A."~AM!l...) 111, .. ~JL- <br />---::) tWplicant ?ignature <br />..'\- ~ ,l, \", ,'~---:-, <br /> <br />--$::J \-qB <br /> <br />Date <br /> <br />,', ~/WARNING <br />Be sure to contact public utilities for loca- <br />tion of underground cables, conduits, pipes, <br />etc. before digging. <br />Call Gopher State One-Call <br />454-0002 <br /> <br /> ........ <br />fEES: <br />Permit $ <br />State Surcharge $ <br />Plan Check $ <br />Certificate of Occupancy $ <br />Water Meter $ <br />Metro SAC $ <br />Construction Deposit $ <br />Contractor's license $ <br /> <br />Office Use Only <br />., FEES (cont.): <br /> <br />Street Deposit <br /> <br /> APPROVAL: <br />$ Fire Marshal <br />$ Engineering <br />$ Zoning <br />$ Plan Reviewer <br />$ Other: <br />$ <br /> <br />Sewer & Water <br /> <br />Assessments <br /> <br />T utal Fees <br /> <br />Receipt No. <br /> <br />. <br />Receipt Date <br />