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<br /> Datc
<br /> Lit.,,-.ii BUILDING PERMIT APPLICATION
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<br /> River PERMANENT SIGN Permit ')
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<br /> i JOB ADDRESS: i 1 '•1.-, - ‘ 1- ENGINEER FEE
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<br /> PERMIT
<br /> APPLICANT IS: 0 Owne-r—i-ContractorlOrher idecribo • , ,'1. 'i --1
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<br /> LEGAL DESCRIPTION STATE SURCHARGE
<br /> Subdivision Lill Block Pi D#
<br /> 1 SEWER
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<br /> PROPERTY OWNER NAME ADDRESS PHONE# ATTORNEY FEE
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<br /> 1-
<br /> 10H-45.;. L l- ..., WI 0 t ;-:'i RAl-t- IQ .1.1 ru 1, i I --v , 4'"°'
<br /> , , ' ° -''t.'.i '' ' '''' ''''' LICENSE CHECK
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<br /> CONTRACTOR/RESPONSIBLE PAR rY LICENSE#
<br /> PLAN CHECK
<br /> ,, --,-. $ . .,..................__........__.. ,.. _...„
<br /> CONTRACTOR ADDRESS PHONE# TOTAL
<br /> —i I ,. -i 7 4 ,,L.,-7-P(-A.,,,,4{-0 j-1ii(f,l),-r*i r-Az-•A f„j,C.,i,,,.._g'.!,.')_Crpi—'
<br /> ARCHITECT/ENGINEER(for Commercial Work) RECEIVED BY
<br /> t ti A i'l'''l''' Address Phi ine# ...
<br /> f.,i O.-r..k, p A,1 1/?r, ;,,, :,,,, ;„,, ,il s fi , APPROVED FOR
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<br /> ISSUANCE BY
<br /> CLASS OF WORK: 0 New 0 Addition 0 R en(it _ l
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<br /> DESCRIBE WORK , t-e CONSTRUCTION
<br /> h A iii i (7112}--:- ryit i
<br /> OCCUPANCY
<br /> GROUP
<br /> VALUATION OF WORK: $ T-- 1 4 (.4 ,0
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<br /> ____ , DIVISION
<br /> 'Separate permits are re:pared tor electriial,plumbing,be,aing, en lint or at unditioning,
<br /> 4,77,4 permit becomes null and tmad i f;work or con st nsetuns anthortzed 4 not commented within IRO dap,or if ..
<br /> TOTAL SQ FT OF
<br /> i unistrnetion at'wit:*4 suspended or abandoned for a period of!8d AO at any timr afier work is summem-ed.
<br /> I *I hereby tert,n(y that(have read and exaMint'd this applie,thon and knoL.-the ktr,me to iit!me and cm-rect. An 'BLDG
<br /> 1 provisiom of laws am ordinance's govern pi„,i this type of work will be rompla wstis.tabether specified henna or
<br /> not. 'The grantiv It pennit does not presua e.t give authority to.,,Itslai,or cancel the put man ni any other #OF Sl'ORTES
<br /> i nate or incapes4?egithaing costar's(thin(JY the perfonnance of s 0/75n-raison,
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<br /> MAX OCCUPANT
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<br /> to uk of- ..o. tract t /Responsible Party Print Name Date
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<br /> USE ZONE
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<br /> Signature of Property Owner Print Name Date FIRE SPRINKLERS
<br /> DYES
<br /> Building Department * Phone 763.635.1060 • FAX 763.635.1090 __,,, 0 NE)
<br /> . .. .._
<br /> Planning Department Date Buildilig Department Date
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<br /> I/111/2M 1 i,n,i Mochtica
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