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CITY OF ST. ANTHONY <br /> 3301 Silver Lake Road / St. Anthony, MN 55418 / (612) 789-8881 • FAX (612) 781-9323 <br /> BUILDING PERMIT N2 5233 33 3 ,j <br /> JOB ADDRESS •-/ ` „ PROPERTY•I.D.NO. <br /> LQ� <br /> (0. SEE ATTACHED SHEET) r) <br /> 1 DE ALA. 6/ �/�. UNPLATTED PROPERTY f C <br /> v/ ' <br /> OWNER C MAI RESS /) ZIP PHONE <br /> ' 2 �2'1 <br /> CONTRACTOR MAILADDRESS I PHONE <br /> 3 q.9 Vff- <br /> ARCHITECT 1AILADDRE�SS ZIP PHONE' REG.NO. <br /> STRUCTURAL ENGINEER MAILADDMESS ZIP PHONE REG.NOt !::Z <br /> 5 <br /> MECHANICAL ENGINEER MAILADDRESS ZIP PHONE REG.NO:• <br /> 6 O <br /> USE OF BUILDING q <br /> 7 CATEGORY: 1 0 2 0 <br /> B CLASS OF WORK: O NEW O ADDITION O ALTERATION O REPAIR O GARAGE O OT4EFg <br /> 9 DESCRIBE WORK r <br /> TAL OF <br /> 1U OCCUPANCY TYPE OF CONST. SO.FEET STORIES <br /> 11 NO.OF REQUIRED <br /> ZONING DWELLING UNITS PARKING <br /> 12 LOT COVERAGE <br /> 13 VALUATION OF WORK$ <br /> 14 [f SPECIAL-CONDITIONS <br /> PERMIT FEE......................................................................$ <br /> PLAN CHECK FEE............................................................$ <br /> STATE SURCHARGE........................................................$ <br /> SAC CHARGE(UNITS).....................................................$ <br /> SEWER..............................................................................$ <br /> �/7 s <br /> WATER...............................................................................$ <br /> LICENSEFEE....................................................................$ G <br /> OTHER...............................................................................$ <br /> PENALTY...........................................................................$ <br /> TOTAL FEE PAID...............................................$ <br /> RECEIPT NO. DATE 'O <br /> SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING,HEATING,VEI(TI- <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 OMPLIED WITH WHETHER SPECIFIED <br /> HERIN OR NOT.T OF A P MIT D ES NOT PRESUME TO GIVE AUTHOR• <br /> ITY TO V OR CANCEL E PR ISION OF ANY OTHER STATE OR LOCAL LAW <br /> RE TING CONSTRUC N ORT PER RMANCE OF CONSTRUCTION. <br /> SIG ATURE OF ST; <br /> CT R O AUTHORIZED AGENT (DATE) <br /> SIGN AT RE OF OWNER IF OWNER BUILDER) ( ATE) NOTICE: Do <br /> e Disturb <br /> ERMIT ISSUED <br /> f Vo� <br /> .. Natural DrainageA <br /> BU NG OFFICIAL (DATE) <br />