05-14-1975 Council Agenda - Laserfiche WebLink

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cc W z 0 O CITY OF LITTLE CANADA 515 Little Canada Road, Little Canada, Minnesota 55117 BUILDING PERMIT NO 484-2177 DO NOT WRITE IN THIS SPACE Name Address City Zip Tel. No. Name Address City Name Zip Tel. No. Address City Zip Tel. No. Registration Number Permit Fee $ State Surcharge $ Plan Check Fee 5 SAC Charge ( Units) $ Other $ $ Penalty $ TOTAL FEE PAID $ Receipt No Date Structure Used As Zone DEMOLISH BUILD ADD ALTER REPAIR MOVE 0 NUMBER STREET LOT BLOCK ADDITION OR TRACT LEGAL DESCRIPTION DETAILS OR REMARKS: VAL FOR SURCHARGE NOTICE SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISION OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY - TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) PERMIT ISSUED BUILDING OFFICIAL (DATE) DO NOT WRITE IN THIS SPACE Type of Const. WIDTH DEPTH SIDE YARD SETBACK FRONT YARD SETBACK LOT SIZE Use Zone Fire Sprinklers Required S: Yes Et No No. of Dwelling Units OFF STREET PARKING SPACES: Covered Uncovered Special Approvals WIDTH LENGTH HEIGHT TYPE OF CONSTRUCTION ESTIMATED VALUE STRUCTURE DETAILS PLANNING COMM DETAILS OR REMARKS: VAL FOR SURCHARGE NOTICE SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISION OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY - TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) PERMIT ISSUED BUILDING OFFICIAL (DATE) DO NOT WRITE IN THIS SPACE Type of Const. Occupancy Group Division Size of Bldg. (Total) Sq. Ft. No. 01 Stories Max. Occ. Load Fire Zone Use Zone Fire Sprinklers Required S: Yes Et No No. of Dwelling Units OFF STREET PARKING SPACES: Covered Uncovered Special Approvals Required Received Not Require° BOARD OF APPEALS PLANNING COMM VILLAGE COUNCIL SPECIAL USE FIRE DEPT SOIL REPORT OTHER PAGE- 2 e