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<br />(). SrtLp .- <br />D [~~CDlllL..L.L.' Ji1 &--1 {Jr b-{3 <br />. .L~~ <br />/' COMMUNITY DEVELOPMENT DEPARTMENT. PHONE: 651-490-2238. FAX: 651-490-2931 <br /> <br />Grading (see supplement) <br />APPLICATION DATE: ~ /3; / b 0 <br /> <br />SITE: I Address: ~() y~ tv. HClM\~tUL <br /> <br />COMMERCIAL BUILDING PERMIT APPLICATION <br /> <br />__ _~ERMIT NUMBER:i1-nn -bbO <br />( Ai;erat~~ <br /> <br />- <br />Other: <br /> <br />Addition <br /> <br />Roof <br /> <br />WORK PROPOSED: <br /> <br />New <br /> <br />Demolition <br /> <br />Ave. <br /> <br />I PIN N1t~;;~;r-- ) 6 /I;} - DOh s- <br /> <br />Lot: <br /> <br />I Block: <br /> <br />Subdivision: <br /> <br />APPLICANT: I Name: vY\ C. GOv...Ct h (OIU S--r. <br />Address: ""\ 7 "'71 .r-., , (/ <br />Do! -:> rt....\ V~..h. t.I,..V Au z JJ, <br /> <br />OWNER: I Name: ST. Rc s,e... 0+ L~ YY\ t\.. <br /> <br />Address: d (] 4 g )J. J-tc{ r"'\ J (' IV' ~ t4 V ~ , <br /> <br />CONTRACTOR: I Name: W\ C G O\..lt) '" CaN s: ,. <br />Address: r V <br />.>Avn..L 0...1 C\bcl....' L <br /> <br />TENANT/SUITE #: <br /> <br />Phone: <br /> <br />b S-f - h3 S -5:,-0 6-0 <br />,0\At,....\ V'v\--IV, c-s:-113 <br /> <br />ST. <br /> <br />Phone: <br /> <br />Phone: h S:- J - b S -~ -- ~() S-o <br /> <br />I License Number: <br /> <br />WORK DESCRIPTION: <br /> <br />Ad~ <br /> <br />$ 33.S.uO <br />1--> e.. v-> c.. u. vb .s <br /> <br />VALUATION (labor & materials): <br /> <br />STRUCTURE TYPE: <br /> <br />Commercial <br />I # of Stories: <br /> <br />Industrial <br />I Sprinkler: <br /> <br />Multi-family <br />Yes No <br /> <br />Public <br />I # of Multi-family Units: <br /> <br />Square Footage: <br /> <br />Acknowledgement and Signature: <br />The undersigned hereby makes application to the City of Roseville to perform the work as herein described. The undersigned further states, under penalty of <br />law, that the work will be performed in accordance with the Minnesota State Building Code, this application. and any approved plans and/or specifications. <br /> <br />Print Name: ~iAl'- \_.IR- PI G (Al' Signature: ~ ~ =.--" <br /> <br />eo. ~~ Owner Architect ,/ j ,J <br />......- " Phone: b~-I-b 5'1,. Lf"J Lf Date: ~~~//OO <br />....--. , I <br /> <br />OFFICE USE ONLY: <br /> <br />SEP ARA TE PERMITS REQUIRED: <br /> <br />Electrical <br />Sewer <br /> <br />Mechanical <br /> <br />Plumbing <br />Alarm <br /> <br />Water <br /> <br />Fire Sprinkler <br /> <br />Other: <br /> <br />FEES: <br />Permit <br />State Surcharge <br />Plan Check <br />Cert. of Occupancy <br />Metro SAC <br /> <br />$ LfBJ- . Ie; <br />$ I b, 15 <br />$ !Ji ~ . L/{) <br />$ <br />$ <br /> <br />Water Meter (# <br />Construction Deposit <br />Contractor's License <br />Assessments <br />Park Dedication <br />Sidewalks <br />Other: <br /> <br />) $ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />Total Fees: $81)~ .3--0 <br />Receipt #: -7) " ~ -t6~01 )'7.'~ <br />Receipt Date: {p 1/<-:.. 0 \".... <br />I <br /> <br />WARNING: Be sure to contact public utilities for location of underground cables. <br />conduits. pipes. etc. before digging. <br />Call Gopher State One: 651-454-0002 <br />