HomeMy WebLinkAboutLA211596 - 19613 Harbor Drive-Permit PackRESIDENTIAL BUILDING
PERMIT APPLICATION
CITY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE
LAKEVILLE, MN 55044
952-985-4440
Office Use Only
__________________
Permit Number
___________________
Received By
___________________
Date Received
___________________
Fee Total
SITE ADDRESS:
MAILING ADDRESS: CITY: STATE: ZIP:
JOB DESCRIPTION:__________________________________ MASTER PLAN: (Number or Address)____________________
LIST OTHER STRUCTURES ON PROPERTY:_______________________________________________________________
ESTIMATED VALUATION: PROPOSED START DATE: END DATE:
(New Residential Only): LEGAL DESCRIPTION: LOT: _____ BLOCK: _____ SUBDIVISION:
APPLICANT IS: RESIDENT OWNER CONTRACTOR EMAIL
NEW MODEL HOME: YES NO (IF YES – ADMINISTRATIVE PERMIT REQUIRED)
PLEASE FILL OUT THE FOLLOWING COMPLETELY (All Contractor information must be as listed on State License)
RESIDENT OWNER
NAME:_______________________________________________________________________________
HOME PHONE #:_____________________________ CELL PHONE:___________________________
GENERAL CONTRACTOR
Homeowner
Contractor
CONTRACTOR:_______________________________________________________________________
LICENSE #:BC______________ LEAD CERTIFICATE#_______________ (PRE 1978 STRUCTURE)
OFFICE PHONE #:_____________________________ CELL PHONE:___________________________
ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________
PLUMBING WORK
Homeowner
Contractor
CONTRACTOR:__________________________________________LICENSE #: PM______________
OFFICE PHONE #:_____________________________ CELL PHONE:___________________________
ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________
MECHANICAL WORK
Homeowner
Contractor
CONTRACTOR:________________________________________ _______________________________
_____________________________ CELL PHONE:___________________________
ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________
BOND #:_______________________________________ EXPIRATION DATE____________________
SEWER/WATER CONTRACTOR
New Construction Only
NAME:________________________________________________ ______________________________
_____________________________ CELL PHONE:______________________________
BOND #:_______________________________________ EXPIRATION DATE____________________
NAME OF APPLICANT (Please Print)DATE
I HEREBY APPLY FOR PERMIT AND ACKNOWLEDGE THAT ALL INFORMATION ON THIS
APPLICATION IS COMPLETE AND ACCURATE. THIS IS NOT A PERMIT AND WORK IS NOT TO
COMMENCE UNTIL SUCH TIME A PERMIT IS ISSUED. ALL WORK WILL COMPLY WITH
LAKEVILLE CITY CODE, THE MINNESOTA STATE BUILDING CODE, AND THE APPROVED
PLANS. INTEREST EARNINGS ON ESCROW ACCOUNTS, IF ANY, WILL BE RETAINED BY THE
CITY TO OFFSET THE ADMINISTRATIVE COSTS ASSOCIATED WITH PROCESSING THE
ESCROW APPLICATION AND REFUND.
OFFICE PHONE #:_
OFFICE PHONE #:_
*Entering your name affirms your intent to comply with the statement above.
*
Submit Application To: permits@lakevillemn.gov
RESIDENTIAL BUILDING PERMIT APPLICATION
PAGE 2
OFFICE USE ONLY
BUILDING PERMIT TYPE REQUIRED INSPECTIONS
SINGLE FAMILY DWELLING BUILDING
DUPLEX AS BUILT
TOWNHOUSE UNITS BUILDING FINAL
DETACHED TOWN HOUSE UNIT
CONDO
REROOF
RESIDE
RES ADDN/REPAIR/RMDL
DECK
PORCH
GARAGES
LOWER LEVEL FINISH
ADDITION
FOUNDATION ONLY
MISCELLANEOUS
DEMO
APPROVED BY:
BUILDING INSPECTOR: Date:
PLUMBING/MECHANICAL
INSPECTOR: Date:
COMMENTS:
CITY BUILDING VALUATION: $
BUILDING PERMIT FEES
$PERMIT FEE
$PLAN CHECK
$SURCHARGE
$METRO SAC
$CITY WATER HOOKUP UNIT
$CITY SEWER HOOKUP UNIT
$LANDSCAPE ESCROW
$TREE ESCROW
$MISC ESCROW
$PLUMBING
$MECHANICAL
$SEWER WATER
WATER METER
PRESSURE REDUCING VALVE
$OTHER
$TOTAL
METER SIZE
PRESSURE REDUCING VALVE
SEWER/WATER
SEWER/WATER
FINAL
STREET DRAINTILE
BUILDING INFORMATION
TYPE OF CONSTRUCTION
ZONING
CODE EDITION
FIRE SUPPRESSION SYSTEM
OCCUPANCY GROUP
MECHANICAL
AIR TEST
FINAL
ROUGH-IN
PLUMBING
FINAL
ROUGH-IN
INSULATION
LATH
DECK FOOTING
FIREPLACE
FOOTING
FOUNDATION
FRAMING
PORCH FRAMING
PORCH FOOTING
POURED WALL
SITE
LOWER LEVEL FINAL
OTHER
DECK FRAMING
LOWER LEVEL FRAMING
LANDSCAPING
DECK FINAL
$
$
ACCESSORY BUILDING
EGRESS WINDOW
UNDERGROUND
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