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2409 <br />�� <br />.� <br />COMMUIV�TY DEVELOPMENT DEPARTMENT • PHONE: 65I-792-7080 • FAK: 651-792-7070 <br />26b0 CIVIC CENTER DR. a ROSEVILLE, MN S51I3 <br />SIGIV PERMIT APPLICATI4N <br />PERMTT NUMBER: <br />WORK PROP�SED: � Permanet►t 0 Temporar�� (Dates: ) <br />PROPERTY TYI'E: 0 Gomniercial ❑ Reside��tial <br />APPLICATION DATE: -. �(�['� � <br />SITE : Address: � � ` ; r • <br />APPLICANT: Nan's- � � �; � S Phone� t � �(7y � � `�� <br />� �� <br />A ress,rJO� ' , � `� ��0�, <br />L 5 w ,r� � � t G r� , t, <br />OWNER: Name: � � ��: Phone: �5` � rE ` <br />L• <br />Address: <br />,_� U t l.L2 N 511� <br />CONTAACTOR: N�me: �`6 S� � y� Phone: „��.� <br />Address� LicenseNumber: �'� ' ������,7�'1 <br />VALUATION (labor & mate:�als}: � <br />WORK DESCRTPTION: � i � ln �� <br />�.� :� Ssa� tn � G � <br />•� s <br />SIGN DETAILS: � �ree Standing .� Illu�ninated <br />C] Wall ❑ Nan-Illuininated <br />��LTidth: �cJ� 11 f� Height AUove Grade: <br />SIZE OF SIGN: <br />Height: �� 3`� % of 17�ai1 Area: <br />. � �. . <br />Sign Location: � <br />Setbacks Front: Side: _ <br />Other: <br />Acicno�vledgement and Signahsre: <br />T[�e undersibmed l�ereby makes �pplica�inc� to the Ciry of �ose�ille to pedorm the work as he�ein descrE6ed. T'he undarsi�ed fiirt3�er statas, iuider penalty af <br />lan�, that the �rork will bc pcdoni3cd in accordance tivi[h thc Mi�u�esota Slale 8uilding Code, tiiis applicaYion, a��d an��proved plans andlor speci�cations. <br />Prir�t Name: �c3�.+IV �—• ��t'Y'c�.u[� Si�ature: � <br />uQ Contractor ❑ O�xmer ❑ �cher: Phane: l- 2- /OV Date: -� -ZCt�`j <br />Praperty Manager Signamre: E-Mail Address: mc�,�►,� ���{�r�,Gr�� ns .�c� 1n.L <br />� <br />Fees: <br />Permrt $ Contractor's License $ <br />Ut�ier: � <br />Appro�als: Total Fees: $ <br />Plan Reviewer Planning ����i�� #� <br />Receipt Date: <br />Engineering <br />