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<br />~SIWfbbE /; <br />COMMUNITY DEVELOPMENT DEP ARTMBNT . PHONE: 651-490-2238 . F AJ{, 651-490-29~ <br />RESIDENTIAL BUILDING PERMIT APPLICATION <br /> <br />WORK PROPOSED: <br /> <br />o New <br />o Deck <br />o Window <br /> <br />PERMIT NUMBER: Ac / -,+gJ- <br /> <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: I=6...\CA:?" 'f2Jc-?U~tMtNT <br /> <br />PlOne:l.osi_4-B5 -"1100 <br /> <br /> <br />&{2,t \)C1.e- S <br />VALUATION (labor & materials): $ <br />WORK DESCRIPTION: RE?l~ <br />~\ n: \J\ rJU L <br />STRUCTURE TYPE: <br /> <br />/ L(C! V ,- <br />I .~., <br />. I I <br />-t /- <br />~....t-t- L1JL0- V> - <br />'" <br /> <br />C&4JACL Wo-vD ~-.JLE WtT1+ <br /> <br />-- Ck/=l4--=t- <br /> <br />/ .I ( <br />( fc ~). y <br /> <br />INDICATE SQUARE <br />FOOTAGE OF: <br /> <br />1'l floor: <br />2nd floor: <br />3rd floor: <br /> <br />Basement: <br />Garage: <br />Deck: <br /> <br />Porch: <br />#of Stories: <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 />1/1-;;"3 <br />.2 .S-(; <br /> <br />o Mechanical <br /> <br />Water Meter (# $ <br />Construction Deposit:ti! $ <br />Contractor's License {)J, ~ r; ,l:'" $ <br />Assessments _~A.J,;..; $ <br />Park Dedication $ <br />Other: $ <br /> <br />^-.Xx)(:>( <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 /> <br />c <br />J <br />