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CITY OF LITTLE CANADA <br />515 East Little Canada Road / Little Canada, MN 55117 <br />FILLING AND GRADING PERMIT APPLICATION <br />Applicant to complete numbered spaces only. <br />IN? I cle <br />Job Address <br />xnxx RI cc ST/e& e <br />Bldg. Permit No. <br />7D 6e /W1(EV ,604. <br />Legal <br />1 Oascr. <br />Lot No. <br />BIk. <br />Tract <br />a.mrs72. oCCJ 5 2NO /4-110 AJ <br />See Attached Sheet <br />Owner Mailing Address ^- . Zip <br />2 .D4IJFM.hJ, /n/c 35-85' ,11, Le- xinccrDnJ 5oITE 270 -4fle) /nL-5 s'sizia <br />Phone <br />6/2 -914 -s 344 <br />C &.L <br />Applicant <br />3 54 -i2[6 <br />Mailing Address <br />Zio Phone <br />I257-4e) -1°440 OF7 ce <br />Architect or Eng. Mailing Address Zip Phone <br />4 P6ottWE J4(Ncz//N4 9/8o Lez0101794) ,¢dE,t)F- C,RCtE PINCH 5523/4 6 /Z- 735 - -109,3 <br />Contractor - Ex cMVpYTOw Mailing Address <br />5 /20(1* fl /WfN70n) 1/96 6erri / c/vN — S toRENeW <br />Zip Phone <br />5-.57 zb Cog? - / 5'' 3 -5-57t9 <br />Purpose of Fill or Excavating <br />6 6Akcv 57 -4A7- TV /9Upit) w /Nre2 cogo,r,ONs <br />Type and Amount of Fill or Excavating <br />7 r,,Ca- ,Qt714.0'*t 0 ,c ,Uut' c fiu- - el577414Tr /3,670 &O yO <br />Special Conditions <br />8 PO2EP 5 /r� ,'9,( 0776/7/65, CuAQ3.F e Olt &,e, N /N/7 aj4-&5 8 / <br />4€1,1/24/1-(..7" TO A0,0 /0 tO /N CDA/Q //lC7/U5 77/tE/7t-Pefr % a/c-E746 Y77 <br />al seT&t COMO 7114 (1' z -#67- /1/1740 CL08/4/4) <br />PERMIT FEE $ <br />NOTICE <br />This permit becomes null and void if filling or grading authorized is not <br />completed within 180 days, or if filling or grading is suspended or <br />abandoned for a period of 180 days at any time after work is cam. <br />menced. Any work not completed within 180 days requires a new permit. <br />I hereby certify that I have read and examined this application and <br />know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether <br />specified herein or not. The granting of a permit does not presume to <br />give authority to violate or cancel the provisions of any other state or <br />local law regulating filling or grading, <br />P4V674f1 416 4Y <br />$15.00 <br />50 cubic yards or less <br />51 to 100 cubic yards 22.50 <br />101 to 1.000 cubic yards - $22.50 for the first 100 cubic yards, <br />plus $10.50 for each additional 100 cubic yards or fraction thereof. <br />1,001 to 10,000 cubic yards - $117.00 for the first 1,000 cubic yards. <br />plus $9.00 for each additional 1,000 cubic yards or fraction thereof. <br />10,001 to 100.000 cubic yards - $198.00 for the first 10.000 cubic <br />yards, plus 540.50 for each additional 10,000 cubic yards or fraction <br />thereof. <br />100,001 cubic yards or more - $562.50 for the first 100,000 cubic <br />yards, plus $22.50 for each additional 10,000 cubic yards or fraction <br />thereof, <br />Other Inspections and Fens: <br />1. Inspections outside of normal business hours 530.00 per hr <br />(minimum charge -two hours) <br />2. Reinspection fees assessed under provisions of <br />Section 305 (g) $30.00 per hrI <br />3. Inspections for which no fee is specifically indicated$30.00 per hr1 <br />(minimum charge - one -half hour) <br />for the total hourly cost to the jurisdiction, whichever is the greatest. <br />This cost shall include supervision, overhead, equipment, hourly wages <br />and fringe benefits of the employees involved. <br />Signature of Contractor or Authorized Agent <br />Signature of Owner (If Owner Contractor) <br />(betel <br />Building Official <br />IDatel <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />WHITE-Inspector <br />CANARY - Customer <br />PINK- OffIce <br />PAGE 141 <br />Permit Validation Ck MO Cash <br />Total Fee Collected S <br />By <br />