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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° 1065 <br />Job Address <br />3oao C NTF(2Vl11 -. Qo. <br />Bldg. Permit No. <br />Legal Let No. <br />1 Deser.00- a9 -aa-I <br />Owner <br />2 -3 op PFtP QS <br />Applicant <br />3 S13 YYie_., <br />Blk. <br />1-00 (VS <br />Tract <br />See Attached Sheet <br />Mailing Address V. I-} , 55110 Zip Phone <br />'483 —iliac <br />I3 -9 lrrcrtP 61-1)0 <br />Architect or Eng. <br />4 <br />Mailing Address Zip Phone <br />Z41C)—j o 4-1:3 <br />Mailing Address <br />Zip Phone <br />Contractor <br />5 SFL.FF <br />Mailing Address <br />Zip Phone <br />Purpose of Fill or Excavating <br />6 LF U F' L_ ?XI S-n IU 6 A-2eA <br />Type and Amount of Fill or Excavating <br />7 I5(JQ y>4a.ras CLYIA-115610.1) 17DPSCEL <br />8 <br />Special Conditions <br />PERMIT FEE$ I2I01O° t', So sok .4 1/217,50 <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 $15.00 <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 — $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 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 (g) <br />3. Inspections for which no fee is specifically indicated <br />(minimum charge— one -half hour) <br />tor the total hourly cost to the jurisdiction, whichever is <br />Thls cost shall Include supervision, overhead, equipment, <br />and fringe benefits of the employees Involved. <br />Signs re of Contractor or Authorized Agent <br />e of Owner (If Owner Contractor) <br />(Date) <br />(Date) <br />Building Official <br />(Date) <br />$30.00 per hrt <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 />Page 44 <br />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />By <br />