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,:35 FAX 651 223 5646 WOLD ARCHITECTS Q002/002 <br /> 1Sam neper t• 'st mti <br /> 1 INITIAL APPLICATION T'OR PLAN RE'V'IE <br /> i <br /> Flja<e fill out this application and return it to the Building Codes and Standards Diviision approximatel four(4) <br /> we:;~ks prior taiyour expected plan review submittal. Failure to submit this form may result in up to a 1_*I=e(3) <br /> W eek delarinithe processing of the plan review application. This initial application will 4elp us expeclite your <br /> I <br /> �. .Y*z;jwtTide <br /> 1 :SfteAd4lass pyo Township <br /> .. <br /> a Ciey151Zipi*L County <br /> vF'v i <br /> 1 O� ly� �8 Owner';Contact Per..ori �' <br /> =Owner Addre" <br /> PA" • Y O+rnd Ftrorre c�tSL:I �dy� . ��:� <br /> City,Steffi,Zip state A¢eney¢WAppliaabl®} <br /> i [ I <br /> 1 _ _ <br /> 'list Funr �C�tL � I JUF�J Finn Con=Person <br /> Cq i Firm Address <br /> 1 i Phone ( ) g2 <br /> i Cery,State,Zip .�� V114 ��jQ-. Fax ( 1 ) <br /> ;;RR­' ;Q Public'(state)building paid(•or by the state or other state agency as a: ©.State College Q Zoo I O D.0-T. Q'.N.R. <br /> :3 ! Q Stats:University O National Guard Q State Hospital, U State Rome. 0 Capita]Complex <br /> Q offs r;specify <br /> ebJ _ Public srizool distngt building of 5100,009 or more in conSmtcGo?t cost <br /> ;O State Licensed>:acitity licensed as a: Q Hospital Q Nursing Home U Correctional Facility . <br /> =; g Supervised Living Facility 4 Free-standing outpatienr Surgical Center <br /> oe*n-specify I <br /> 1 ;Cl New Building Consiruction ❑Addition N(i�modeling othei;specify. <br /> ,; =UBC occ*vcy clammCation(s): <br /> UHC Type of Construction: <br /> d :Project Dgscriptioa: - T .�1m1� sMG»p <br /> 6tt/�' REar•� <br /> _�- TOW Projected Consttvction Valuation: �jC' � �C1.cl:' <br /> 1' <br /> Upo1 <br /> x receivmg the completed initial application we will confirm that we <br /> are the propor jurisdiction fa=the <br /> project, assign it a project number for tracking and determin 'e if the cityhnunicipality will do the playa :aviusw, <br /> thc[inspectionk both or neither. We will notify you of the project number,where to submit your documents for <br /> rcvitsiW and.lio�r the inspections will be handled. If delegated to tha city/rt�tpicipality,you will only n ed to <br /> follow their procedures and fee schedule. If your submittal is to the-BCSD, our standard application f'coeess <br /> wlt need to�z frollowed. <br /> ' I <br /> I lberebjt ae ow hat is a it tr'o�is not a Building'permit, nor does it author ke the stunt of const•-retion. <br /> ' • ; � . � .cit <br /> A>;pli <br /> Date <br /> i .9 Codes aud•5tandards Division,408 Metro Square Building, 121 7�'Place East,St.Paul,MN 551 01 ZB 31 <br /> Voice:651.296.4639: Fax:651.297.1973; T'T'Y: 1.800.627.3529 and ask for 296.9929 <br /> i <br /> I I <br /> a <br />