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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 />N° 1092 <br />Job Address <br />BIdg, Permit No. <br />Legal <br />1 Descr. <br />Lot No. <br />Blk, Tract <br />See Attached Sheet <br />2 YOwneer ! \\ Mailing Address L <br />c. C r tLf\ Jr)hn.a'J �L ��� ��10�C <br />Zip <br />Phone <br />Clica n t Mailing Address ,. Zip <br />3 4_ O rJ 6 c q t <br />2 - -7S1t)- <br />Architect or Eng. <br />4 <br />Mailing Address Zip <br />Phone <br />Contractor <br />5 <br />Mailing Address Zip <br />Phone <br />Purpose of Fill or Excavating <br />6 5n m C �.L r✓� Lc 1 <br />7 <br />Type and Amount of Fill or Excavating <br />rc0 <br />G o a �- �L C F 04 pi, c Jl `r� S <br />8 <br />Special Conditions <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 com- <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 />50 cubic yards or less 815.00 <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 $40.50 for each additional 10,000 cubic yards or fraction <br />thereof. <br />100,001 cubic yards or more — $502.50 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 Fees: <br />1. Inspections outside of normal business hours <br />(minimum charge —two hours) <br />2. Reinspection fees assessed under provisions of <br />Section 305 lg) <br />3. Inspections for which no fee is specifically indicated <br />(minimum charge — one-half hour) <br />for the total hourly cost to the jurisdiction, whichever is <br />This cost shall include supervision, overhead, equipment, <br />and fringe benefits of the employees involved. <br />ignature of Contractor or Authorized Agent <br />Signature of 0 <br />ner (I <br />Owner Contrz)ptor) <br />(Date) <br />(Date) <br />Building Official <br />(Date) <br />830.00 per hr1 <br />$30.00 per hr1 <br />$30.00 per hr1 <br />the greatest. <br />hourly wages <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />WHITE—Inspector <br />CANARY— Customer <br />PINK — Office <br />Permit Validation Ck MO Cash <br />Total Fee Collected S <br />By <br />Page 2 <br />