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��i <br />COMMUNITY DEVELOPMENT DEPARTMENT. PHONE: 651-490-2238 • FAX: 6X-490-2931 <br />COMMERCIALBUILDINGPERMIT APPLICATION <br />PERMIT NUMBER: �' <br />wORK PROPOSED: NeW Addition Alteration Roof <br />r n see sup le nt _ Demolition Other:��4��'�4 1 D�'""—Cn.2Gf.[ �2 <br />APPLICATION DATE: <br />SITE: Ad ess: a,a.7 �r�� VC�or.q <br />APPLICANT: I <br />Address: �� �� <br />OWNER: I ..�.... <br />aaaress: <br />CONTRACTOR: <br />//'It 77#/G�n e �a .G1(_ <br />� ,� S� aM / Md <br />.r/yc .� /�it Ca^e lP„yFi <br />JaMP <br />"��{ i�//V �'��.� YIN Numb�Cl�r / �' O � ����W / <br />i�v <br />Subdivision: <br />Phone:/,�� yO/ 'd,?�J, <br />w a <br />sr�a6 <br />Phone: <br />one: �SI y�y ' Q��.r <br />TENANT/SUITE #: <br />VALUATION (labor & materials): $ a IS, vCx� .� O <br />WORK DESCRIPTION: ' , <br />STRUCTURE TYPE: Commercial Industrial Multi-family Public <br />Square Footage: # of Stories: Sprinkler: # af Multi-family Units: <br />Yes No <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 A�Iimiesota State Building Code. this application, and any approved plans and/or specifications. <br />Print Name: ���"'4�� � �"�'� Signature: ���� _ <br />Contractor Owner Architect <br />Phone: (�r�� �� 43�� Date:9�� <br />-T- <br />SEPARATEPERMITSREQUIRED: Electrical Mechanical Plumbing Water <br />Sewer Fire Sprinkler Alarm Other: <br />FEES: Water Meter (# ) $ <br />Permit $� �,�3�•�� Construction Deposit $ <br />State Surchar�,� $ � ��i$ /Q%. �D Contractor's License $ <br />Plan Check $ � ,5� .�ssessments $ <br />Cert. of Occupancy $ Park Dedication $ <br />Metro SAC Sidewalks $ <br />Other: $ <br />WARNING: Be sure to contact public utilities for location of underground cables, Total Fees: $ <br />conduits, pipes, etc. before dlgging. ReCelpt #: <br />Call Gopher State One: 651-�454-0002 Receipt Date: <br />