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9® <br /> CITY OF ST.ANTHONY <br /> 3301 •Silver Lake Road j.Si.Antpny, MN 55418 / (612) 789-8881 - FAX (612) 781-9323 <br /> v v BUILDING PERMIT No. 4 417 <br /> JOB ADDRESS PROPERTY-I.D.NO - <br /> TRACT (Q SEE ATTACHED SHEET) <br /> LEGAL LO NO. BLK UNPLATTED PROPERTY <br /> DESC. <br /> OWNER - �tA1 ADDRESS <br /> / 21P PH j- <br /> 2 -[,�j{ � � '- i �G c CG i �f LJ 9'177 <br /> CONTFiAG70R MAILADDRESS LP PHONE LICENSE NO. <br /> 7 _ <br /> ARCHITECT / / MAILAODRESS ZIP PHONE REG.NO. <br /> 4 (/ <br /> ZIP PHONE REG.NO. <br /> STRUCTURAL ENGINEER MAILADDRESS <br /> 5 <br /> MECHA,VICALENGINEER MAILADDRESS LP PHONE REG.NO. <br /> 6 <br /> USE OF BUILDING CATEGORY:1 0 2 0 <br /> 7 <br /> e CLASS OF WORK: 0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR .0 GARAGE 0 OTHER <br /> g DESCRIBE WORKG L r tr c/j2l L���� (/�c [-G'' <br /> G` J OTAL NO.OF <br /> 10 OCCUPANCY TYPE OF CONST. <br /> SO.FEET STORIES«/LL_�� �� <br /> / NO.Of REQUIRED <br /> � <br /> DWELLING UNITS PARKING <br /> t1 <br /> ZONING <br /> y LOT COVERAGE 7 <br /> VALUATION OF WORK S [� <br /> SPECIAL CONDITIONS <br /> 1< rC <br /> PERMITFEE...............................................L.....................S i <br /> PLANCHECK FEE............................................................S <br /> STATESURCHARGE........................................................$ <br /> SAC CHARGE(UNITS).....................................................$ <br /> SEINER..............................................................................$ <br /> WATER...._...................._..................................................S <br /> LICENSEFEE..........................................._....................5 <br /> OTHER.._._...............................-......-........_.....--....-..S <br /> PENALTY_.._......................._............................._.......$ I <br /> TOTAL FEE PAID................................--...S 00 <br /> RECEIPT NO. DATE - <br /> SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL.PLUMBING,HEATING,VENTI•' <br /> LXnNG OR AIR CONDITIONING AND FIRE SPRINKLERS. <br /> BECOMES THIS PERMIT I WORK OR CONSTRUCTION AUTHORIZED <br /> IS NOT COMMENCED WI'TH N 80 DAYS,OR IIFCO CONSTRUCTION OR WORK IS SUS. <br /> PENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS <br /> COMMENCED. <br /> I HEREBY'CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW <br /> THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND ORDINANCES <br /> GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HERIN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOR- <br /> ITY TO VIOLATE OR CANCELTHE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW <br /> •REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> lk <br /> SIGNATURE OF ONTR*CTOR HORIZED AGENT (DAT <br /> ATE) 1 • • • <br /> SIGNATUr E OF 9WNER(IF OWN ��B ILL R) I ^n <br />