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CITY OF ST. ANTHONY 14 <br /> 3301-Silver Lake Road/,S#.Anthony, MN 55418 / (612) 789-8881 • FAX (612) 781-9323 <br /> BUILDING PERMIT No. 4417 <br /> JOB ADDRESS ! PROPERTY-I.D.NO. <br /> LEGAL�LN BLK. , TRACT (�SEE -7 ATTACHED SHEET) <br /> UNPLATTEO PROPERTY <br /> 1 DESC. <br /> 2 OWNER b1A14ADO RESS� / / ZIP PH <br /> CONTRACTOR MAILADDRESS bG ZIP PHONE LICENSE NO. <br /> /7 <br /> 3 <br /> ARCHITECT / / MAILADDRESS' ZIP PHONE REG.NO. <br /> 4 (�� <br /> STRUCTURAL ENGINEER MAILADDRESS ZIP PHONE REG.NO. <br /> 5 <br /> MECHANICAL ENGINEER MAILADDRESS ZIP PHONE REG.NO. <br /> 6 <br /> USE OF BUILDING CATEGORY: 1 0 2 O <br /> 7 <br /> B CLASS OF WORK: 0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 GARAGE 0 OTHER <br /> g DESCRIBE WORK: ` ae(� l ' ,� dl� <br /> C F N SOT FEET S ORIESL�/�C-rlLe'�� ' J <br /> 10 OCCUPANCY TYPE OF CONST <br /> NO.OF REQUIRED <br /> 11 ZONING DWEWNG UNITS PARKING <br /> 12 LOT COVERAGE <br /> VALUATION OF WORK S <br /> a SPECIAL CONDITIONS <br /> PERMIT FEE................................................:.....................S ) <br /> C%C <br /> PLANCHECK FEE............................................................S <br /> STATESURCHARGE........................................................S <br /> SACCHARGE(UNITS).....................................................S <br /> SEWER..............................................................................S <br /> WATER...............................................................................S <br /> LICENSEFEE....................................................................S <br /> OTHER...............................................................................$ <br /> PENALTY...........................................................................E <br /> TOTAL FEE PAID...............................................S <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 <br /> ENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ATAN YTI E AFTER WORK S <br /> COMMENCED. <br /> 1 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 ONTRXCTOR THORIZED AGENT (DAT <br /> SIGNATU OF WNER (IF OWN B IL R) )ATE) <br /> • • • <br /> c�%=i��Sa., , �i1�1rt}10"RMI IS /�� (.i C� ® • " <br />