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<br />Dle.,C!Dllll...LD < <br />' .L ~rn::7VTDIJD l' // <br />COMMUNITY DEVELOPMENT DEPARTMENT. PHONE: 651-490-2238. FAX: 651-490-29{ <br />RESIDENTIAL BUILDING PERMIT APPLICATION <br /> <br />PERMIT NUMBER: Ac / -(~gJ- <br /> <br />WORK PROPOSED: <br /> <br />o New <br />o Deck <br />o Window <br /> <br />o Alteration <br />o Roof/Siding <br />o Draintile <br /> <br />o Addition 0 Garage <br /> <br />o Grading (see supplement) 0 Demolition <br />Other: t="6.Jc..e f2k--?O~tMe:N\ <br /> <br /> <br />PlOne'losi_l4--95 -9100 <br /> <br /> <br />1S~'2t <OC1.E"' s-.-.... <br />VALUATION (labor & materials): $ <br />WORK DESCRIPTION: RE? <br />\k\\t \J\ ~U L <br />STRUCTURE TYPE: <br /> <br />-- (~i:f '-Vi- <br />-' L.!{{ (/ ~ (: F[-; {/ Y -- <br />I '--' <br />. I I <br />,,'-t...t ~Lt.fL.r-- G--;- <br />[b-4)A(L WovD ~rJLE WlTI+ <br /> <br />INDICATE SQUARE <br />FOOTAGE OF: <br /> <br />l'l floor: <br />2nd floor: <br />3rd floor: <br /> <br />Basement: <br />Garage: <br />Deck <br /> <br />Porch: <br />#of Stories: <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: \(,p-" l f-(dFf . Signature:~~(l~ . . <br />o Contractor ~ Owner 0 Architect Phone: ~:6i-4l() .- 1 UJD Date: ~1.(p~i- <br /> <br /> <br />SEPARATE PERMITS REQUIRED: 0 Electrical <br /> <br />FEES: r <br />Permit $ I / /.;(0 <br />State Surcharge $ :2 . S-U <br />Plan Check $ <br />Cert. of Occup. $ <br />Metro SAC $ <br /> <br />o Mechanical 0 Plumbing <br /> <br />Water Meter (# ) $ <br />Construction Deposit , _ "i {! $ <br />Contractor's License (/)~ ~ '/4" $ <br />Assessments .~,J.!..; $ <br />Park Dedication $ <br />Oili~ $ <br /> <br />o Water <br /> <br />o Sewer <br /> <br />^-xx.);;:>( <br /> <br />WARNING: Be sure to contact public utilities for location of underground cables. <br />\ conduits. pipes, etc. before digging. <br />r' Call Gopher State One: 651-454-0002 <br /> <br />Total Fees: $ <br />Receipt #: <br />Receipt Date: <br /> <br /> <br />c- <br />:> <br />