Laserfiche WebLink
<br />.-~,-:::-=.r';~ <br /> <br />., <br /> <br />~~ <br /> <br />Building Application <br /> <br />'do <br />f' I: <br /> <br />C( <br /> <br />Community Development Department. 2660 Civic Center Drive · Roseville, MN 55113 · Phone: 612.490.2238 · FAX: 612.490.2931 <br /> <br />FOR OFFICE USE ONLY: IPIN No. I Planning File No, <br />Permit No. I Date Applied For Date of Permit <br /> I Address I Build~Name Tenant Name <br />SITE: :J ''14 ~ d. ))O(~\ r II \ .'(ui'. ..-....~ -- <br /> . I' <br /> I Name I , J Add ress <br />OWNER: ~( ...:( ,Z, :',J .J -{, \ -:'h (~ tfL h l. J.J..J{ r )t5' '4 Lv'oO -I b\ \c~ e..- .'.)T <br />City . Stale I Zip Code I rePhon\ No, ~J I <br /> I, I ~' ;1)1\) 5'S1\~ 061 L/~4' ?fl IL . <br /> ( ,. I. . I \ H ~ <br /> I Name r I Address <br />CONTRACTOR: ..). P. <br />Cily I State I Zip Code I Telephone No. r State License No. <br />ARCHITECT: I Nr/I ~ I Add ress <br /> , <br />City State I Zip Code I Telephone No. <br />DESCRIPTION OF WORK BEING DONE: ,j('(V-~ \ (CJ X' Id ') GjGt y d.(}. r ) .j r\O. Cl <br /> I <br />Floor ~rea (square feel) I Stories I I COST OF PROJECT (labor & materiaIS):T ~700o()O <br /> 1/,1 ..)'~ ~r <br /> .' IFront I Back I Side I Side <br />SETBACK (in feet): <br />Starting Date I Finishing Date <br /> F" · ',\ \qq0 <br /> ... '. I <br /> . ,( 12GV.tN.. <br />COMMENTS: ~C. :: ~ \lie. (I 11,(1 l L ((,\ (.rJ -J 0 'I \ C' \' \(0 ,f) ./ <br /> U <br />PLEASE NO TE: Electrical, plu,,!binJ:; ~eatin& fire sprinkler and alarm each require a separate permit. To obtain a permit application on the Internet: <br /> http: II www.cl.rosevllle.mn.us <br />Acknowledgement and Signature: WARNING <br />The undersigned hereby makes application to the City of Roseville to perform the work as herein Be sure to contact publ ic uti I ities for loca- <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 and! tion of underground cables, conduits, pipes, <br />or speci fications. etc. before digging. <br />.,,~ " . . h t. MJl.., {n, -;/.. A.,LUf! .!?..- q - 1\ CiA Call Gopher State One-Call <br /> . k......"" ."_ <br /> Applicant Signature Date 454-0002 <br /> Office Use Only <br /> FEES: FEES (cont.): APPROVAL: <br /> Permit $ Street Deposit $ Fire Marshal <br /> State Surcharge $ Sewer & Water $ Engineering <br /> Plan Check $ Assess ments $ Zoning <br /> Certificate of Occupancy $ $ Plan Reviewer <br /> Water Meter $ $ Other; <br /> Metro SAC $ Total Fees $ <br /> Construction Deposit $ Receipt No. . <br /> , <br /> Contractor's license $ Receipt Date <br />