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<br />~SEVIbbE <br />COMMUNITY DEVELOPMENT DEPARTMENT · PHONE: 651-490-2238 . FAX: 651-490-2931 <br />RESIDENTIAL BUILDING PERMIT APPLICATION <br /> <br />o New <br />o Deck <br />o Window <br /> <br /> <br />PERMIT NUMBER: A 0 / -;.Lg;;;.. <br /> <br />WORK PROPOSED: <br /> <br />~/- -." <br />/ "Zlti Alteration <br />, ~,.; Q-;~~fISiding <br /> <br />./ o Draintile <br /> <br />o Addition 0 Garage <br /> <br />o Grading (see supplement) 0 Demolition <br /> <br />Other: t="El~U? \~--?(j\~ME:N\ <br /> <br />SITE: <br /> <br />APalL >\ G! 1L'Jq~ <br /> <br />Address:, W . \. ~ I. /\. 1,.-:::: <br />~~~4';" C;~\A-DUi '.~1'\-cn r-tVC; <br />B o,*Wp 'onal}: <br /> <br /> <br />APPLICATION DATE: <br /> <br /> <br />OWNER <br /> <br />Address: <br /> <br />l-\ Pt-D L~\ -gEr\/C~ <br />-,~ l-E ..t ~ L- <br />1;{2.{vC-tt" ST. ~LKJ<L\) MN <br />$ SODO- <br />WORK DESCRIPTION:R eY1 k~E l::::::-\.( \ <:;il N ~ <br />,jU, \ <: \j\ ~U L <br />STRUCTURE TYPE: 0 Singk F'1\mil)lAttached <br /> <br />Address: <br /> <br />::tCo~ - 4' <br /> <br />License Number: <br /> <br />- Cc-::f '-F1- <br /> <br />VALUATION (labor & materials): <br /> <br />k;; <br />~!:h <br />C~iJA\L LUuJD H::-~jLf <br /> <br />--, f <br />7)1(<(( (tll\.",~ <br /> <br />/' <br />"-..r <br /> <br />WITl+ <br /> <br />NEW CONTRUCTION INFORMATION: <br /> <br />o Single Family Detached <br /> <br />o Other: <br /> <br />INDICATE SQUARE <br />FOOTAGE OF: <br /> <br />',1\t;Mbr;-- <br />2nd floor: /' \ C <br />3ro--fioor ' ,',/ '- - <br />\" . <br /> <br />.J~'~ <br /> <br />Basement: <br />Garage: <br />beck: <br /> <br />Porch: <br />#of Stories: <br /> <br />, -'ii, J <br /> <br />OFFICE USE ONLY: <br /> <br />SEP ARA TE PERMITS REQUIRED: <br />FEES: /' <br />J II. '7 " <br />Permit $ I . . ;;7'- '-" <br />-,\ <br />State Surcharge $ ') ,j U <br />-'- <br />Plan Check $ <br />Cert. of Occup. $ <br />Metro SAC $ <br /> <br />o Electrical <br /> <br />o Mechanical <br /> <br />Water Meter (# <br />Construction Deposit . O-j /J <br />Contractor's License (C1L~AK-9''-- <br />Assessments /A--~-} l- <br />Park Dedication <br />Other: <br /> <br />o Plumbing <br />) <br /> <br />o Water <br /> <br />o Sewer <br /> <br />$ -'- <br />$,.~;';~ <br />$ XXX~X <br />$ <br />$ <br />$ <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 /> <br />Total Fees: $ <br />Receipt #: <br />Receipt Date: <br /> <br />--it:;; zr I i =-3 ,'I <br />j/,;; ) / oj <br /> <br />