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CITY OF ST. ANTHONY 3301 Silver Lake Road / St. Anthony, MN 55418 / (612) 789-8881 - FAX (612) 781-932� BUILDING PERMIT (V2 5233 -2 35 JOB ADDRESS l „PROPERTY-I.D.N0. n'` � ry,1 O NJ LEGAL LQ� _ (V` B CT `�� (0 SEE ATTACHED SHEET) r 1 DESC.Q��E/ / '/l / UNPLATTED PROPERTY f OWNER C MAI RESS /J ZIP PHONE 2 CONTRACTOR M ILADD SS I PHONE 3 72i -_z-�Jd 991 ARCHITECT � lA1LADORFTSS � ZIP PHON15 REG.NO. STRUCTURAL ENGINEER MAILADDRIESS • ZIP PHONE REG.NO% 5 MECHANICAL ENGINEER" MAILADDRESS - - - ZIP- PHONE__ _._REG..NO" _ 6 O , USE OF BUILDING C2 , 7 CATEGORY: 1 0 2 0 e CLASS OF WORK: 0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 GARAGE 0 OT4EFg 9 DESCRIBE WORK �- 10 TAL OF OCCUPANCY TYPE OF CONST S0.FEET STORIES 11 Lc NO.OF REQUIRED ZONING DWELLING UNITS PARKING 12 LOT COVERAGE 13 VALUATION OF WORK$ 14 EEE�V SPECIAL CONDITIONS PERMIT FEE......................................................................$ / d PLAN CHECK FEE............................................................$ STATE SURCHARGE........................................................$ SAC CHARGE(UNITS).....................................................$ SEWER..............................................................................$ WATER...............................................................................$ LICENSE FEE....................................................................$ G OTHER...............................................................................$ PENALTY...........................................................................$ TOTAL FEE PAID...............................................$ RECEIPT NO. DATE O SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING,HEATING,VEATI- LATING OR AIR CONDITIONING AND FIRE SPRINKLERS. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUS- PENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL OMPLIED WITH WHETHER SPECIFIED HERIN OR NOT.T OF A P MIT D ES NOT PRESUME TO GIVE AUTHOR- ITY TO V OR CANCEL E PR ISION OF ANY OTHER STATE OR LOCAL LAW RE TING CONSTRUC N OR T PER RMANCE OF CONSTRUCTION. �(O 33 SIG ATURE OF O CT R Oh AUTHORIZED AGENT (DATE) SIGNAT,. RE OF OWNER IF OWNER BUILDER) ( ATE) NOTICE: Do Not Disturb �L ERMIT ISSUED Natural , s • 4UN G O FFICIAL (DATE)