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Planning Approval <br />Approval <br />Fire Marshal Approval <br />Building Appro <br />Site Address: <br />,�-�`� '� 15153 Nowthen Boulevard NW. <br />Ramsey, MN 55303 <br />763-433-9850 - phone <br />763-433-9848 - fax <br />--7 /6 / 6/s/-11- <br />Permit Application <br />Building NI( <br />Plumbing <br />Heating <br />Sewer <br />Legal Description: Lot 4 Block g. Subdivision <br />or PID # <br />Owner Name: D --!L c M 0.c .1- 011, ; . Vine, 5 Contractor: ILL.ir::,-1-.or i)- S Sic: , <br />Address: 7 / (:: jifI-f . Li, },7 Address: 3tI c.v'td ti111/jeL <br />City/State: i ?(..,-,r►=5ytv' ) Zip: 3.3 Cit /State:4)1.6 .. Zip:,'3 <br />y <br />Phone: 7( . c 7 / .)---0 / State License No. <br />04,e/ 7'?- k4 --O We' <br />Contact: ' i- iLle 14/ Phone: 7'- S7j$5iC Fax: 763 - S-76 <br />Description of Work:�.`` <br />?-61—G <br />Valuation (including l r : labor): <br />Does this plan qualify for SS1300.0160 yes , no. If yes, the master plan number is <br />The undersigned acknowledges that he/she has read this application and the above information is correct and accurate. <br />Applicant also understands by signing this application that he/she could be held responsible as representative of this <br />project. f Ear iolation of compliance with all applicable laws and ordinances of the City of Ramsey. <br />- e <br />Signature of Applicant or Authorized Agent Date <br />NOTICE: This is an application onty. Permit will be issued after City approval and payment of fees. <br />****************************** FOR OFFICE USE ONLY ****************************** <br />Engineering Appicmvj Type of Const <br />�,/ Date,, <br />� --640 Occupancy Classification <br />Date <br />Special Conditions <br />s.4t�o Total $ <br />Date <br />