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<br />BUILDING PERMIT APPLICATION <br />(Fill Out Completely) <br /> <br />DATE <br /> <br />1. Si te Address <br /> <br />(Office Use Only) <br /> <br />2. Legal Description: Lot <br />Other: <br /> <br />Block <br /> <br />Addition <br /> <br />3. <br />4. <br />5. <br />6. <br /> <br />Zoning Classification: <br />Ow n e r ~U.lwttU...:;:e.+ <br />Arch i tect Jwc>M4/'VUe~eA- <br /> <br />&3 <br />/240 ;v,9!'!JI .J7; <br />Ad d re s S jjJ.IMmrN'? 74~ A/l;V, r~ 4a/ <br /> <br />Address ~ A-f 441)Y/L-, <br /> <br />Phone t'r7-t./~,o <br />Phone ~ <br /> <br />Contractor <br /> <br />Address <br /> <br />Phone <br /> <br />2 Sets of Plans complete, <br /> <br />Yes <br /> <br />No <br /> <br />;- Yes <br /> <br />No <br /> <br />1 Certificate of Survey. (Showing all easement & location' <br />of structure) <br /> <br />Yes No <br /> <br />1 Complete energy loss. <br /> <br />7 . Est i mated cost $ <br /> <br />/2:; ,jilt!, ~ <br /> <br />8. <br />9. <br /> <br />City Water and Sewer Available: <br /> <br />Yes X <br />, <br /> <br />No <br /> <br />Percolation Test for private Sewer System required. Yes No~ <br />(Submit with plans &, design prior to issuance of building perm~ <br /> <br />10. Is lowest level above the 100 year flood level. <br /> <br />Yes >z No <br /> <br />11. Grade of first floor or garage will be 12" or more above crown of <br />street. Yes X No <br />/ <br /> <br />12. Will site drainage conform and be compatible to street and neighborhood <br />drai nage pattern. Yes X No <br />/ <br /> <br />13. "R" Factors are shown for walls, ceilings, etc. Yes;C No <br /> <br />14. Building use <br /> <br />S~(tlJj:(..{ <'T AT.tON <br /> <br />ACKNOWLEDGEMENT AND SIGNATURE <br /> <br />The undersigned hereby represents upon all of the penalties of law, for <br />the purpose of inducing the City of New Brighton to take the action herein <br />requested, that all statements herein are true- and that all work herein <br />mentioned will be done in accordance with the ordinances of the City of <br />New Brighton, the State of Minnesota, and rulings of the Building Department. <br /> <br />SIGNATURE <br /> <br />APPROVED <br />