HomeMy WebLinkAboutLA185095 PERMIT
City Of LakCville Permit Type: Mechanical
20195 xolyoke Ave Permit Number: LA185095
Lakeville,MN 55044
(952)985-aaao * L R 1 8 5 0 9 5 *
www.ci.lakevillemn.us Date Issued: 10/16/2020
Site Address: 17283 Fairgreen Ave
Lot: 000 Block: 003 Addition: Section 11 Twn 114 Range 20
PID: 22-01100-03-012
Use: * z2 - 0 1 1f7J0 - 03 - 0 1z *
Description:
Sub Type: Heating/Air Cond
Work Type: Replace
Description: Furnace&Air Conditioning Replacement
Comments:
Fee Summary: Description Amount Revenue Code
ME-Residential(Minimum) $40.00 1000-4154
Surcharge- $1.00 $1.00 1000.2127
Total: $41.00
� � � � �
��.�- �
�
Contractor: - applicant - Owner:
MOBILE HOME IMPROVEMENTS North Creek Co
10900 Courthouse Blvd E %W R Block
INVER GR HEIGHTS MN 55077 369 Kellogg Blvd E
(651)451-1297 Saint Paul MN 55101--141
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO: (1)THE APPROVED PLANS&
SPECIFICATIONS;(2)THE APPLICABLE CITY ORDINANCES&CODES;AND(3)THE MN STATE BUILDING CODE.
��`\J�
ApplicantlPermitee: Signature Issued By: Signature
Office Use y
�cHAx�c�.�����Lic�TTox l��'�z��� �
Pemut Number
C1TY OF LAKEVII.LE ` ., � ;` '
� , . BUII,DING INSPECfIQNS DEPARTMENT ���Q $�
20195 HOLYOKE AVENUE `
LAKEVII.LE,MN 55044 ��' 4� '��
952-9$5-d�40 Dateiteceived
�nrwcv.lakevillemn.�G>v ��� �
�1-ezmif�ee
DATE�--_����Z,� YOiJR E-MAIL ADDRESS \� � ��"��+�� • C.�'�
5ITE ADDRESS S� "'J" �" �'> �V��1 r� �� �.C. Yl
�
TENANT o � SUITE NO.
Tfi�A�PLiCANT iS: �it�S�Ei�i'ff OWNEit �,CONTRACTOR
NAME
RESIDENT OWNER �DRESS �A-�,�,,... `(�,�— �r�,.e
CTT3� S�'A� Z3P
DAYTIME PHONE#WHERE YOU CAN BE REACHED Q�Z2y p 2 Z_�
COMPAA1�i'NAME (Y��l�� �� .o,ro ��j�.-^�
BOND#:_�1(� � pp,�� S�''j EXPII2ATION DA'fE c Za�
CONTRACTOR p�DRESS��,q�ee, ��["�1r-•t�.��\J� �
Company 3�tame must be as
listed on State Bond CITT' �� � '`S�-��st':Lti[�-� STAT�Y� ZIPS-`S�"1;)
OFFICE PHONE#_(pj 1 y SI 12�"'� FAX# (o,'�"'� 5�Q��
CaNTACT la1AME� 4.�►�sL P�L3N£CP 12 3�r3��ti'.'��
COMMERCIAL ONLY RESIDENTIAL ONLY
❑NEW HVAC SYSTEM ❑FURNACE ❑VENTILATION
❑AII�CDNDITIONER I�,FUItNA�CE/AIR CDNI? ❑MISC
❑REFRIGERATION ❑AIR COND ❑ADDNlREPAIR/REPLC
�GAS PiPING �GARAGE HEA'i'ER C�iN FLOOR WATER HEAT
PERMIT TYPE �����prJ �FIREPLACE ❑BOILER REPLC
C�FTREPLACE (�GAS PIPING
❑ADDN/REPAIR/REPLC
❑IN FLOOR WATER HEAT
❑MISC Residential PermitsAvailable on-line
�NEW �ADDITION ❑ALTER/REMODEL
TYPE OF WORK
❑REPAIR �ItEPLACE ❑DEMOLITION
JOB DESCRIPTION:'��\•=,-c.� ��z..►^��. � p��,r�'
,--
SYSTEM MAi�: J��Lcr� SYSTEM SIZE:�l C�O�
RESIDENTIAL FEES: $40.00+State Surcharge�$1.�0)
COMMERCIA.L FEES:
J�B COST: $ E���ple:$12,09�doh Cast
1-1J2%of contract cost up to$10,0�OG $1fl,000.(?Q x 1.5%_ $150.OQ
1%of cost above$14,000 plus surcharge + $ 2,OOOAO x 1°l0 = + 20.00
(Surcharge=Contract Cast x.00US) + S 12,Ub0 x.ilOQS = + 6.00
TOTAI. � =$O.pQ = 176.00
Miniffium crf$40 fNl+State St�reharge(S1.Oti) �'---
I �tereby apply for a mechanical permit and I aclmowl�ge that the information above is complete and accurate; that the work will be in
conformance with the ordinances susi codes of the City of Lakeville and with the Minnesota Mechanical Codes;that I understand this is not a
petmit but only an application for a parmit and work is not to start without a permit;that the work will be in accordance with the approved plan in
the case of all work whieh requires review and approvai of plans.
�1A�ViE OF APFLIC�'+T�'{P�ease�rintj: ��,-v��c._._. �c__.l�lr,�s--� Dafi�: t c'�- s'L�
SIGNATURE OF APPLICANT:
�a��:.���,�zaw�s�. �