Building Permit Application Date Received
Ile BUILDING PERMIT APPLICATION Date Notified
A,Ibertvi 5959 Main Avenue NE Date Paid
Small.rows.„Living.Big Cfty Life. Albertville, MN 55301 Ck, Cash, CC
Phone: 763.497.3384 Fax 763.497.3210 Permit#
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Site Address: BUILDING PERMIT FEES
Business Name:
The Applicant is: Owner Contractor Tenant I Permit
Legal Description:PID# Surcharge
Addition Lot Block
Owner: I Plan Check
Name Address I Engineering(site)
I I
City State Zip I Mechanical
Email I Fireplace(s)
I I
Phone(H) (W) (C) I Plumbing
I I
Contractor: I Sewer
Company Name License#
I I Water
I Address City St Zip
Water Meter
I I
Contact Person Email I City WAC
I I
Phone: (W) (C) (Fax) I JP WAC
I I
Architect: I SAC
Name Address
Storm Water
I City State Zip
I I License Check
E-Mail
Other
Phone (W) (C) (Fax)
I I TOTAL
I Type of Work:
HNew Construction Residential Addition Alteration Finish Bsmt I Type of Const.
New Construction Commercial Garage/Shed Reside/Reroof Fireplace I Use of Bldg
Tenant Finish Plbg Htg Deck
I I
Description of Work: I Occupancy Group
I I
Occupancy Load
Size of Structure: Total Square Footage:
Length First Floor I Zoning
Width Second Floor I Code Used
Height Basement
Garage
Estimated Valuation of Work: $ I Are Fire Sprinklers Required:'
Yes []No
Separate permits are required jor electrical,plumbing,heating or fireplace. 1 herehy apply for the above consideration and declare
that the information and materials submitted with this application are in compliance with City Ordinance and Policy Require- I Date Approved
ments and are complete and accurate to the best of mp knowledge. It is applicants responsibility to locate and establish the
elevations,if needed,of all site improvements. Required adjustments at owners expense. I understand that all City incurred I Fire Dept•
professional fees and expenses associated with the processing of this request are the respansihility of the property owner and/or
applicant and will be promptly paid Ifpayment is not received from the applicant,the proper y owner acknowledges and agrees I City Engineer
to be responsible.
Applicants Signature Applicants Printed Name Date Notify of Assoc&Covenant
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
Public Works
Approved by Building Official Value Approved Date
City Planner
Special Conditions or Comments: