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07/29/2069 13:58 952-935-9544 MINNESOTA RUSCO PAGE 62/62 <br /> � � <br /> �Total �ee: $ /3J, � �t �• D� Date Received: �/3� G�' <br /> Entered By: �,Y�.c� Pernvit#: �.OG9' DD ,.�� <br /> � <br /> CITY OF 0124N0 - $UILDIN� PE�XT APPLICATION <br /> Al� xnformation must b�e submitted in fr�l� be�ore plan review wiIl be started. <br /> (please print all infornlation) � <br /> TIiE APPT,TCANT IS: (ccrcle one) OWNER 0 CONTRACTOR <br /> JOS SITE ADDXtESS: _ f�D � ��� ZIP: ��J���Q <br /> � � s� /_� <br /> NA1V� OF O'VVNER: � � // � PHONE: (home}�oj' ��� �`-'`5� <br /> �� �� (wor&) [o/Z• $�g' �17I <br /> MAILING ADDRESS: ,�I� C�TY: ZTP: <br /> CONTRACTOR: �Y�I� • PHONE: qJ�o� • g�'f�P�� <br /> CONTACT PERSON: •f �p MOSII�E/PAGER: 1�rZ- 280• �OoS <br /> MAILING ADDRESS: 55�8 �an� ��f� CITX: �}�j�p ZII': �6�y�; <br /> STATE LICENSE: # �/�_ <br /> ARCHx'T�CTlENGINEER: PHUNE: <br /> M�Il�TG ADDRESS: CxTY: ZIP: <br /> NAME: REGISTRATION# <br /> TYPE OF 'VVO1tK: 1�T�w Addition Accessory Structure <br /> Move Remodel,'Alteration T,and Alteration �_r� <br /> PROPOSEn'W�QRK(descxibe in detai�: 0 z C�� �d�1rS /�� <br /> .� � � �fd' � <br /> �� <br /> STORIES: S�. FEET OF EACH FLOOR: <br /> NO. OF SEDROOMS: � GARAGE STALLS: ATT. DET. <br /> //�g Oo <br /> ESTIMATED CONSTRUCTION VALUATION (excluding land): � ��"TU <br /> Y hereby ap�l� for a buxlding permit and I acknawledge that the in.formatxaz�above is compleC� and <br /> accurate; that the work will be in confoimancE wirh the ordinances and codes of the City and with <br /> rhe State Buildin,g Code; that I understand this is not a permit and work is �at to start without a <br /> pezmat; and that the work wil� be in accordance with th� ap�roved plan. <br /> � <br /> APPLICAN'X"S SZCCNATURE: ° DATL: � <br /> .NOTE! Parade �'Hames events requi separ e permit approval by Police Depar�merat and <br /> City Council 60 days prior to the event. Non permitted everzts wzll noC be atlowed. <br /> 5 <br />