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BUILDING PERMIT <br />City of Lake Elmo (PLEASE PRESS HARD) <br />Bus: 777-5510c� ,r J I No. 7� <br />Site Address. "9'911 VC;'J o N_ Owner.).A R .ZS� Phone?%%�%1 <br />Contractor.. A1111,,5 Address / Phone <br />Owner's Address �89/ c Vtw�V/!li Legal Description of SlteL -1 Z k�'*-SES zmm�'nz <br />Zone Flood Plain: NA, FW, FF ttR{ E�37y�S Zo�� <br />Set BacksL o c�o , /so /y6 Lot Size ZJ�&3 Fire Zone <br />Front R. Side Back L. Side <br />Type of Construction _ Size of Bldg 7 x^s' Square Feet V <br />Frame Brick Masonry' ; <br />Type of Construction No,o. of of Stories Starting Date <br />OFFICE USE ONLY <br />Building & Remodeling Plumbing, Heating, A.C., <br />Venting & Mechanical r S.A.C. $ <br />1. Alteration <br />2. Remodel <br />3. Addition <br />4. New Const. _ <br />5. Roof Et Siding <br />6. Insulation <br />7. Garage bUl <br />8. Swimming Pool <br />9. Decks Et Porches T <br />10 Sheds _ <br />11. Curb Cut Et Driveway <br />Er Parking Lot T <br />12. Other <br />Estimated Cost $ ©01 <br />(including labor). <br />Depth/Dimension of Trench:_ <br />Cost of Sewer and Water Hookup <br />A. Repair <br />B. Alter <br />C. New <br />............................ <br />1. Type of heat <br />2. No. Bathrooms <br />3. Other <br />Plumbing Heating <br />Venting Mechanical <br />Sewer Water <br />This permit is granted on the condition that all ORDINANCES will be <br />respected and that the above information is true and correct. This permit ex- <br />pires after 1 year, but all exterior appearances must be reasonably complete <br />Building Official <br />Date <br />Sewer -Septic <br />$ <br />Connection No. <br />_ <br />W.A.C. <br />$ <br />Plumbing fee <br />$ <br />Surcharge <br />$ <br />Heating fee <br />$ <br />Surcharge <br />$ <br />Vent, A.C. fee <br />$ <br />Surcharge <br />$ <br />Bldg. <br />$ <br />Surcharge <br />$ <br />Investigation fee <br />$ <br />Other <br />9 <br />Plan Review $ <br />Surcharge Total $ <br />TOTAL <br />PERMIT FEES $ <br />Receipt No. <br />Date <br />Planning Director - Date <br />