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Permit Application <br />7550 Sunwood Drive NW. Building <br />Ramsey, MN 55303 Plumbing <br />Mgt 763-433-9850 - phone Heating <br />763-433-9848 - fax Sewer <br />Perin it 4 V- A- d,_ 1:77 <br />Site Address: (-7 O l H f alnwa�j 10 N ca . Ro ms e.�:J i RA J , S --S'303 . <br />Legal Description: Lot Block Subdivision 04 / 11'11,,�/,/�ViGL� <br />Or PID # �� - 3 2- 2 Year Built /q 9 (a <br />Owner Name: Vou� i►�S� <br />Address: (0701 Hi9kwaI{ 10 /1.W. <br />City/State: Raw, le -!j , VvtAI zip: 5-5-30 3 <br />Phone: ^Z&3 <br />E-mail: A Mcunicla,5aaa0C0 Qf,40.i m^/• OS <br />Contractor: '-r S K IM-1S4-eC5 a,,J ,rV4td..> f T'V C. <br />Address: W1 - l5at Ne LN, Nw <br />City/State: Ravvt.5e•4 , Mnl . zip: S5'303 <br />State License No. 13G-4 5- ot 10 15 -- <br />Lead Cert. Firm No. & Exp. Date: A1afi - l d 8 ya 3" 1 <br />Exp. L//r/16 <br />Contact: 5 e-04 kAJ i Ina Phone: Co102 - 30 - Y5'39 Fax: <br />Description of Work: c, vdy4 i I i r +k4k- At ew <br />rV <br />T1000 COolM <br />Valuation (including labor): 301000 <br />Does this plan qualify for SS1300.0160 yes no. If yes, the master plan number is <br />The undersigned ac nosvledges that he%rhe has read this application and the above information is correel and accurate. Applicant also understands <br />by signing driscation thathe/she could be held responsible as represenlative of this project for any violation of compliance widr all applicable <br />laws and or�tya / o IT, e rry of Ra sey. <br />9 �Sr <br />igna ure of Applicant or Authorized Agent Date <br />NOTICE: This is an application only. Permit will be issued after City approval and payment of fees. <br />FOR OFFICE USE ONLY <br />Engineering Approval: <br />Da r <br />Planning Approval ss 2-4-V f <br />Fire Approval <br />Date <br />Septic Approval <br />Building Approval <br />Revised 2/6/2014 <br />?jL0fM j--tq d v� <br />jPei It 1 ew <br />Gti J PVr^lt-J <br />Dale <br />Date <br />Type of Const <br />Occupancy Classification <br />Special Conditions <br />Environmental Approval <br />Total $ <br />