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CITY OF LITTLE CANADA <br />515 Little Canada Road East • Little Canada, Minnesota 55117 <br />(651) 484 -2177 • Fax: (651) 484 -4538 <br />, Address <br />-l� /' / / .��/. <br />Legal Description <br />OwaerC <br />V <br />1 o "ti <br />Contrac <br />BUILDING PERMIT NO. 8 <br />' <br />e n <br />/,J � <br />L .L �.' r N(/V 95/7 <br />Lot No. <br />Elk. <br />Property I.D. No. //C.,/ ) <br />Tract (e attached sheet) Unplatted Property <br />Engineer / Architect �. <br />/ Mailing Addres \ Zip Phone., <br />Mailing Adt>ress ' Zip Phone <br />Mailing Rddtess <br />GrG'r�� <br />Plumbing Contraptoj Mailingcddre ;s / \ <br />• <br />Hean ra ctor <br />/a Act, r r / ns ( Ar Ma ing ddressN3 �-- <br />Zip <br />Phone <br />I Use of 8 ildipg _'J /�,r /,,� <br />/0 Lij.Ci- A�1 ( ( /e L7 <br />Zip <br />Phone <br />Zip <br />Phone <br />Licenses No. <br />Reg. No. <br />Licenses No. <br />Licenses No. <br />CATEGORY 1O 20... <br />;lass of Work <br />Describe War <br />/ jv r / t ✓G'`� <br />)ccu <br />❑ New - ddition <br />❑ Alteration 0 Repair ❑ Garage ❑ Other <br />Cl <br />/C) <br />47-71 <br />c r //L `% <br />Zoning <br />pecial Conditions <br />Type of Const: <br />e <br />Total Sqr Feet <br />No. of Dwelling Units <br />No. of Stories_ <br />equired Parking <br />V -' .ation of Work $ • <br />ermit Fee (1) R-101-32210: .; <br />State Surcharge G- 101 -20821 $ <br />'an Check Fee R- 101 -34104 $ <br />SAC Charge (Units) G- 101- 20863 $ <br />Sewer R- 450 -37260 $ <br />ater R- 450 -37160 $ <br />-ark R- 456 -34105 $ <br />Other $ <br />;natty $ <br />TOTAL FEE PAID $ <br />Receipt No. Date <br />EPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, <br />ENTILATING OR AIR CONDITIONING AND FIRE SPRINKLERS, <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED <br />3 NOT COMMENCED WITHIN 120 DAYS, OR IFCONSTRUCTION OR WORK IS SUSPENDED <br />ABANDONED FOR A PERIOD OF 120 DAYS ATANYTIMEAPTER WORK I5 COMMENCED. <br />I HERBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW <br />THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />"OVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />EREIN OR NOT THE GRANTING OFA PERMIT DOES NOT PRESUME TO GIVE AUTHORITY <br />D VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW <br />REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />anature-of Contractor or Autt)etriie '(gem <br />s ;gea[afepr'ccwner (If Owner Budder) <br />PERMIT ISSUED <br />Date <br />i <br />/• Date <br />Building Official Date <br />Attachment #5 <br />