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` ` <br />COMMUNITY DBVELOPMENT DEPARTMENT. PHONB:651-490-2238: FAX:651-490-2931 <br />C011IMF.RCIAL BUILDING P�'RMIT APPLICATION <br />WORK PROPOSED: N�`" Addition <br />r ing aee supplerr�nt Demolition <br />�:PPLICATION DATE: <br />SITE : `°" <br />t.oc: <br />APPLICANT: <br />"�' 3� � <br />OWNER � <br />Addreae: <br />CONTRACTOR <br />a�a� �-� u� <br />TENANT/SUITE #: <br />/'iit t7�irt�c�. e <br />�ct • <br />� <br />.J4� <br />VALUATION (labor & materials) <br />WORK DESCRIl'TION: <br />STRUCTURE TYPE: Commercial <br />,.. i ... � � <br />. . . .;1 ♦ <br />Alteration <br />MN Ss-N9 <br />� �r � <br />s�l .,/ .rw � s�-ia� <br />'�►l�i �4I�L �P��'/ on <br />, on <br />$ a IS o�rw . � v <br />���1�,.� <br />Industrial <br />� �.��J' <br />�SS-i y�'y - o��-r <br />Mul <br />Yes No <br />Roof <br />�� 4��-�-� �'`�4� <br />- �3 -3 -� / <br />Public <br />AC�QLOVV�eIIt 8II(� $1�1�tU!@: <br />The underei�ed hereby makes application to the City of Roaeville to perform the work as herein described. The undersigned further states, under penalty of <br />law, that the work will he performed in accordance with the Minnesota State Building Code. this application, and any approved p� and/or apecifications. <br />PrintName: ��""'�� � '6'�'�'� Signature: ���'� ' `' <br />Contractor Owner Architect � : f; � • �� � �' <br />Phone• <br />��f"/� S%J'S� O�d'� Da�: �°�ae� <br />SEPARATE PERMITS REQUIRED: ���� <br />Sewer <br />I� t g �, l,(03� �5" <br />State Surcharge $ I07 � SD <br />Plan Check $ �5`�' <br />Cert. of Occupancy $ <br />Metro SAC $ <br />Mechanical Plumbing <br />FireSorinkier Alarm <br />Water Meter (# <br />Construction Deposit <br />Contractor's License <br />Assessments <br />Park Dedication <br />Sidewalks <br />Other: <br />) � <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Water <br />WARNIIVG: Be aure to contact public utilities for location of underground cables, Total Fees: $ <br />conduits,pipes,etc.beforedigging. Receipt #: <br />Call Gopher state On� 651-454-0002 Receipt Date: I <br />