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CITY OF ST ANTHONY <br /> 3301�Silyer Lake Road-,/�3jjtnt.h.o9y, IVIN 55418 / (612) 789-8881 FAX (612) 781-9323 <br /> BUILDING PERMIT No. 4417 <br /> JOB ADDRESS PROPERTY-I.D,NO. <br /> LEGAL LO NO. TRACT IQ SEE ATrACHED SHEET) <br /> UNPLATTED PROPERTY <br /> DESC. <br /> OWNER WAILADDRE S ZIP PHOtF� <br /> 2 - I <br /> ec - ZIP PHONE LICENSE NO. <br /> CONTRACTOR MAILADDRESS <br /> 3 <br /> ARCHITECT MAILADDRESS ZIP PHONE REG.NO. <br /> STRUCTURAL ENGINEER MAILADDRESS ZIP PHONE REG.NO. <br /> MECHANICAL ENGINEER MAILADDRESS ZIP PHONE REG.NO, <br /> 6 <br /> USE OF BUILDING CATEGORY: 1 0 2 C3 <br /> 7 <br /> 8 CLASS OF WORK: El NEW 0 ADDITION 0 ALTERATION U REPAIR 0 GARAGE 0 OTHER <br /> 9 DESCRIBE WORK: <br /> OTAL NO.OF <br /> lo SO.FEET STORIES <br /> OCCUPANCY TYPE OF CONST <br /> No.OF REQUIRED <br /> 11 ZONING DWELLING UNITS PARKING <br /> 12 LOT COVERAGE <br /> 13 VALUATION OF WORK S <br /> SPECIAL CONDITIONS <br /> 14 <br /> PERMITFEE.................... ...... ........... .......................s <br /> PLANCHECK FEE.............. . ........... ... . .............$ <br /> STATE SURCHARGE.......................... .. .......... . ....$ <br /> SAC CHARGE(UNITS).................. ... ... ..... ..- -S <br /> SEWER........................ ...................... - ­ ­$ <br /> WATER................... .......................................................s <br /> LICENSEFEE........................ .............................. S <br /> OTHER..............................................................................s <br /> PENALTY................. .... ...... ................. ...............$ <br /> TOTALFEE 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 SLIS- <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 /> S SIGNATURE OF ONTRXCTOR THOMZED AGENT (DATP <br /> ,:�535�L -C-, <br /> IGNAT4 ONT�XCTOR THOI <br /> PATE) <br /> ;SIGNA4TU OF WNER (IF OWN B IL R) 0 0 <br /> PERMI IS <br /> q q <br /> mi"n er,%c I IA1 (4DLE) <br />