HomeMy WebLinkAboutLA183850 PERMIT
City of Lakeville Permit Type: Building
20195 Holyoke Ave Permit Number: LA183850
Lakeville,MN 55044
(952)985-4440 �K L R 1 8 3 8 5 0 �K
www.cilakeville.mn.us Date Issued: 09/09/2020
Site Address: 17700 Exley Ave
Lot: 001 Block: 075 Addition: Section 11 Twn 114 Range 20
PID: 22-01100-75-010
Use: * Z2 — 0 1 100 — 75 — 0 1PJ *
Description:
Sub Type: Reroof Construction Type:
Work Type: Replace
Description: Applicant must call for inspection.
Census Code: - Occupancy:
Zoning:
Square Feet: 0
Comments:
Fee Summary: Description Amount Revenue Code
Res Reroof/Reside/Windows/Re-Deck $50.00 1000-4151
Surcharge- $1.00 $1.00 1000.2127
Total: $51.00
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Contractor: Owner: - Applicant -
Country View Lmtd Ptnshp c/o Ofelia Cabasal
1500 Mcandrews Rd W Ste 100
Burnsville MN 55337
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO:(1)THE APPROVED PLANS&
SPECIFICATION5;(2)THE APPLICABLE CITY ORDINANCES&CODES;AND(3)THE MN STATE BUILDING CODE.
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Applicant/Permitee: Signature Issued By: Signature
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RESIDENTIAL BUILDING I��� �`�U
PERMIT APPLICATION Permit tJwnber
CITY OF LAKEVILLE �, �j ��- `
� � � BUILDING INSPECTIONS DEPARTMENT Received By ��
20195 HOLYOKE AVENUE � �`�
LAKEVILLE,MN 55044 �Date Received �
952-985-4440 ��r�� � ��
N�ww.lakevillemn.Qov ��-�
�1 Fee Total
siTE aDnx�ss: A` % �C%'�J ��.'. L.�Y L1�,�- A�C M/�.1,�Cr,I�EMAIL
MAILING ADDRESS: CITY:/�?G�� �x L�1'-y �.('�'���iJCj1�'�r J�#���STATE: ZIP:
JOB DESCRIPTION:_ �,�,-}�,T����� MASTER PLAN: (Number or Address)
LIST OTHER STRUCTURES ON PROPERTY: C'��t�
ESTIMATED VALUATION: � C3����•�� PROPOSED START DATE:S�P• 1]' �z'+�-c? END DATE ` - � e�S, ��
(New Residential Only):LEGAL DESCRIPTION: LOT: BLOCK: SUBDIVISION:
APPLICANT IS: RESIDENT OWNER CONTRACTOR
NEW MODEL HOME: YES �(IF YES-ADMII�TISTRATIVE PERMIT REQUIRED) ISD#
PLEASE FILL OUT THE FOLLOWING COMPLETELY (All Contractor information must be as listed on State License)
NAME: ��� L1' �. ��,����t_-
RESIDENT OWNER HOME PHONE#:��j o���7 ���� `���t � CELL PHONE: ����,
GENERAL CONTRACTOR CONTRACTOR:
Homeowner LICENSE#:BC LEAD CERTIFICATE# (PRE 1978 STRUCTURE)
Contractor OFFICE PHONE#: CELL PHONE:
ADDRESS: CITY: ST: ZIP:
PLUMBING WORK CONTRACTOR: LICENSE#: PM
Homeowner OFFICE PHONE#: CELL PHONE:
Contractor ADDRESS: CITY: ST: ZIP:
MECHANICAL WORK CONTRACTOR:
Homeowner OFFICE PHONE#: CELL PHONE:
Contractor ADDRESS: CITY: ST: ZIP:
BOND#: EXPIRATION DATE
SEWER/WATER CONTRACTOR NAME:
New Construction Only HOME PHONE CELL PHONE:
BOND#: EXPIRATION DATE
INTEREST EARNINGS ON THE ESCROW ACCOUNTS, IF ANY, ARE RETAINED BY THE CITY TO OFFSET THE
ADMII�TISTRATIVE COSTS ASSOCIATED WITH PROCESSING THE ESCROW APPLICATION AND REFUND. I HEREBY
APPLY FOR A BUILDING PERMIT AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND
ACCURATE;THAT THE WORK WILL BE IN CONFORMANCE WITH THE ORDINANCES AND CODES OF THE CITY AND
WITH THE STATE BUILDING CODE, THAT I UNDERSTAND THIS IS NOT A PERMIT AND WORK IS NOT TO START
WITHOUT A PERMIT AND THAT THE WORK WILL BE IN ACCORDANCE WITH THE APPROVED PLAN.
NAME OF APPLICANT(Please Print) ��E L 1� L',����f��— DATE S�('� �7� ��-��c�
APPLICANT'S SIGNATURE: ��y�-e.� �'.�t���
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RESIDENTIAL BUILDING PERMIT APPLICATION
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