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<br />COMMUNITY DEVELOPMENT DEPARTMENT. PHONE: 651-490-2238 . FAX: 651-490-2931 <br />COMMERCIAL BUILDING PERMIT APPLICATION <br /> <br />PERMIT NUMBER:.:Ad) -L(q h <br /> <br />APPLICATION DATE: <br /> <br /> <br />Addition <br /> <br />Alteration <br /> <br />Roof <br /> <br />WORK PROPOSED: <br /> <br />Demolition <br /> <br /> <br />SITE: <br /> <br />Address: <br /> <br />;).7;)7 <br /> <br />Akrlh <br /> <br />(,I,c ./or,let <br /> <br />d~/k <br /> <br />/I1N <br /> <br />srJl:J <br /> <br /> <br />OWNER: <br /> <br />3~]O <br />~j{ <br /> <br /> <br />Subdivision: <br /> <br />Lot: <br /> <br />APPLICANT: <br /> <br />.};,r. <br />/14# <br /> <br />Phonei;1 ~!y -tJ7t1"J~ <br />SJ/~' <br /> <br />Address: <br /> <br />(aft ~".,';I" <br /> <br />Phone: <br /> <br />Address: <br /> <br />CONTRACTOR: <br /> <br />Name: (" <br />..)(( At f <br /> <br /> <br />License Number: <br /> <br />&.5'1 "IJ'I - 07'..r <br /> <br />Address: <br /> <br />TENANT /SUITE #: <br />VALUATION (labor & materials): $ <br />WORK DESCRIPTION: <br /> <br />d/5;ooo.OO <br /> <br /> <br />STRUCTURE TYPE: <br /> <br />Commercial <br /># of Stories: <br /> <br />Industrial <br /> <br />Multi-family <br /> <br />Square Footage: <br /> <br />prj er: <br /> <br />Yes <br /> <br />No <br /> <br />Public <br /> <br /># of Multi-family Units: <br /> <br />Acknowledgement and Signature: <br />The undersigned hereby makes application to the City of Rosevil1e 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: ~V r ~I Signature: ~c ~ <br /> <br />CE?ntract;;o Owner <br /> <br />Architect <br /> <br />Phone: ( ,6;-1) </J'~ cJ:?J'.:> <br /> <br />Date: ~ ".;,s 02 <br /> <br />" <br /> <br />OFFICE USE OJ\,I,1": <br />SEPARATE PERMITS REQUIRED: Electrical Mechanical Plumbing Water <br /> Sewer Fire Sprinkler Alarm Other: <br />FEES: &211-' ~ f ~ 1J 1.iq' Water Meter (# ) $ <br />Permit Construction Deposit $ <br />$ .. ~ I Contractor's License $ <br />State Surcharge $ ~ 107.6D <br />Plan Check $..:~ ~1() lObl/-.13'f Assessments $ <br /> . Park Dedication $ <br />Cert. of Occupancy $ Sidewalks $ <br />Metro SAC $ Other: $ <br />WARNING: Be sure to contact public utilities for location of underground cables, Total Fees: $ <br /> conduits, pipes, etc. before digging. Receipt #: <br />Call Gopher State One: 651-454-0002 Receipt Date: <br />