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CITY OF ST. ANTHONY 66 <br /> 3301 Silver Lake Road / St. Anthony, MN 55418 / (612) 789-8881 - AXr (612) 781-932; <br /> BUILDING PERMIT NO 4715 <br /> JOB ADDRESS„ _O /te/[ ^y� PROPERTY-.I.� <br /> LEGAL LOT NO. BLK TRACT (0 SEE ATTACHED SHEET) <br /> 1 DESC. UNPLATTED PROPERTY <br /> OWNER , AILADDRESS ZIP I <br /> CONTRACTOR V V MAILADDRESS ZIP PHONE LICENSE NO. <br /> 3 e OW Ne <br /> ARCHITECT MAILADDRESS ZIP PH NE"� REG.NO. <br /> 7 7� .l u.S TE'�I/ ,2 /0/� 7�3 �L�g ,sD6 <br /> STRUCTURAL ENGINEER MAILADDRESS r��� ZIP�� ���� REG.NO. <br /> 5 J �J ��j 9 <br /> MECHANICAL ENGINEER MAILADDRESS ZI ON E <br /> 6 <br /> USE OF BUILDING /,� 6 <br /> CATEGORY:1 ❑2 D elA�f� 33� <br /> 8 CLASS OF WORK: 0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 GARAGE 0 OTHER <br /> 8 DESCRIBE WORK <br /> 0-1 �/ TOTAL NO.OF <br /> to <br /> OCCUPANCY TYPE CONST. SO.FEET STORIES <br /> `11 / NO.OF REQUIRED <br /> ZONING li DWELLING UNITS PARKING <br /> 12 LOT COVERAGE <br /> VALUATION OF WORK$ <br /> SPECIAL CONDITIONS <br /> PERMITFEE......................................................................$ <br /> PLANCHECK FEE............................................................$ <br /> STATE SURCHARGE........................................................$ <br /> SAC CHARGE(UNITS).....................................................$ <br /> SEWER..............................................................................$ <br /> WATER...............................................................................$ <br /> LICENSEFEE....................................................................$ <br /> OTHER...............................................................................$ <br /> PENALTY...........................................................................$ <br /> TOTAL FEE PAID...............................................$ <br /> RECEIPT NO. DATE <br /> SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING,HEATING,VENTI- <br /> LATING OR AIR CONDITIONING AND FIRE SPRINKLERS. <br /> THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED <br /> IS NOT COMMENCED WITHIN 180 DAYS, OR IF 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 CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW <br /> REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) <br /> SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) <br /> PERMIT ISSUED <br /> • , i i r <br />