Laserfiche WebLink
<br />D[e~CD11ILLD /' <br />, J..~lJIJTII1DI:J. 'i/ <br />COMMUNITY DEVELOPMENT DEPARTMENT @ PHONE: 651-490-2238 e FAX.: 651-490-29~ <br />RESIDENTIAL BUILDING PERMIT APPLICATION <br /> <br />WORK PROPOSED: <br /> <br />aNew <br />o Deck <br />a Window <br /> <br />PERMIT NUMBER: Ac / -t~gd- <br /> <br /> <br />o Alteration <br />o Roof/Siding <br />o Draintile <br /> <br />a Addition 0 Garage <br /> <br />o Grading (see supplement) 0 Demolition <br />Other: -- f2k~~-rv\tN\ <br /> <br />INDICATE SQUARE <br />FOOTAGE OF: <br /> <br />1'1 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, ~~fi ~ {-(Off . Signature: ~~ . <br />o Contractor 'ill Owner 0 Arcltltect Phone: ~-6"iJ.{t( -ct UYD Date: ~1'-'(o-L <br /> <br /> <br />SEP ARA TE PERMITS REQUIRED: <br /> <br />FEES: <br />Permit <br />State Surcharge <br />Plan Check <br />Cert. of Occup. <br />Metro SAC <br /> <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />/ /1-;l.3 <br />:) . .S-O <br /> <br />o Mechanical <br /> <br />Water Meter (# ) <br />Construction Deposit 'i - € <br />Contractor's License tt.!d r: "':... <br />.Assessments ~ <br />Park Dedication <br />Other: <br /> <br />$ <br />$, <br />$ _ x.x:X -k X. <br />$- <br />$ <br />$ <br /> <br />Total Fees: $ <br />Receipt #: . <br />Receipt Date: <br /> <br /> <br />s <br /> <br />WARNING: Be sure to contact public utilities for location of underground cables. <br />\ conduits, pipes, etc. before digging. <br />t. can Gopher State One: 651-454-0002 <br />