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city of <br />� <br />fiver <br />13065 Orono Parkwzy <br />Eik River, mN 55330 <br />JOB ADDRESS <br />SUBDIVISION <br />DATE <br />PER1l IT 0 � � �IPJ�,3 <br />-BUILDING <br />PET IT APPLICATION <br />r� v) <br />-Co—jNTR,kCTOR <br />NAME ADDRESS <br />KZ, Y _— ADDRESS <br />DESCRIBE-YYLlIiiS. <br />VALUATION OF WORK: <br />LOT <br />a <br />COjMPLETIONv DATE <br />ENERGY CODE USED FOR THIS PROJECT (R <br />ENERGY CODE OPTIONS: [] CATEGORY 1 <br />S,'PARATE PE"IT'SARE.REDFARED FOR <br />VENTILATING OR AIR Co-NTITIONING. <br />BLOCK PID <br />PHONE r= <br />PHONE tri <br />PHONE n <br />❑ 2000 ENERGY CODE <br />THIS P.ERIVIIT j3ECDIIIES NULL AND VOID IF WORK O-R CONSTR UCTT'O" A UTHOBJZED . 3 <br />NOT C+Dtvl'iIENCED WITHTY I80 OD F 180 BAYS AT ANY TDYfE AFTER WOR.gIS SPENDLD <br />R ABANDDNED FOR A PERIOD <br />OFFICIE USF ONLY <br />x.hl,QyII a <br />SURCHARGE <br />ATTORINEY FEE <br />LICKS SE CHECK <br />PLAN CHECK <br />TOTAL <br />APPL RECD BY <br />APPROVED FOR <br />ISSUANCE BY <br />TYPE OF' <br />CO�FSTRUCTION <br />GROUP <br />SIZE OF BLDG <br />(TOTAL SQ FT) <br />O <br />CO3,liVENCED. OF STORIES <br />I HEREBY CERTIFY THAT IIIAVE READ AND EXA_Vr? ED THIS ApPLICATIONA.ND R N©W <br />LI <br />THE SAhaTE TO BE TRUE AND <br />O WILL BE COMPLIED JWIT'H S OF WHETHER S AND �PECIF EDS 1EAX OCC LOAM <br />GOVERNING THIS TYPE <br />HERELN OR IVOT THE GRANTING OF A PERMIT DOES NDT PRESUME TO <br />AUTHORITY TO VID_LATE OR CA.NCEE THE PT2QVISIONS OF ANY OTHER STATE OR <br />I D C L LAW RESULAT FVG COIVSTR U'CTION OR THE PERFORMANCE OF CONSTR UCTION. USE ZONE <br />SIRE <br />SIGNAT OF C ?V71?A R <br />DATE SPRLq LERS <br />� QUiRED <br />� YES <br />crrrntd'77fRF OF 0WNER DATE [] NO <br />BUILDING & ZON'LNG DEPARTMENT • PHONE (763) 441-4900 - FAX (763) 441-7425 <br />