City of Biwabik, Mn

CITY OF BIWABIK, MN

BUILDING PERMIT APPLICATION–PERMIT # ______

------APPLICANT COMPLETE INFORMATION BELOW ------

Project Address: ______

Legal: Lot No: ______Block: ______Tract: ______

Property Owner: ______Phone: ______

Address: ______

General Contractor: ______Lic.#: ______Phone: ______

Plumbing Contractor: ______Lic.#: ______Phone: ______

Mechanical Contractor: ______MN Bond ID# ______Phone: ______

Purposed Use (Check): Dwelling: ___ Private Garage: ___ Deck: ___ Home Addition: ___ Pole Bldg: ___ Siding: ___

Finish Basement: ___ Three Season Porch: ___ Business/Commercial: ___ Fireplace: ___ Other: ______

Description of Project: ______Dimensions: ______

Use and Occupancy: ______Type of Construction: ______

Estimated Value: ___$______Lot Size/Dimensions: ______

This permit becomes null and void if work or construction authorized is not commenced with 180 days, or if construction or work is suspended or abandoned for a period of 180 days at any time after work has commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction.

Name [Please Print]: ______Phone: ______

Address: ______

Signature: ______Date: ______

------CITY USE ONLY ------

PLANNING: Zoning District: ______Minimum Setbacks Required: Front: ______

Side: ______Rear: ______Road Right of Way: ______

Other: ______

Reviewed by: ______Date: ______

Subject to the following conditions: ______

______

BUILDING: Reviewed by: ______Date: ______

Subject to the following conditions: ______

______

DESIGN REVIEW/HOA: Reviewed By: ______Date: ______

Subject to the following conditions: ______

______

PUBLIC WORKS/CITY ENGINEER: Reviewed by: ______Date: ______

Subject to the following conditions: ______

______

------FEES ------

Building Permit: ______Plan Review: ______State Surcharge: ______

Erosion Control Permit: ______Plan Review: ______State Surcharge: ______

Other: ______: ______Plan Review: ______State Surcharge: ______

Sub-Totals: ______

TOTAL DUE: ___$ ______ Date Paid: ______

Date Permit Issued: ______Issued By: ______

Original: City Copies to: Building Official & Assessor & Applicant