HomeMy WebLinkAboutLA223469-Park Manager Approval Form
MANUFACTURED HOME PARK
MANAGER APPROVAL
CITY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE
LAKEVILLE, MN 55044
952-985-4440
www.lakevillemn.gov
Office Use Only
___________________
Permit Number
___________________
Received By
___________________
Date Received
REQUIRED FOR APPLICATION:
Park Manager approval form with site plan on reverse.
Manufacturer’s approved installation manual.
Application must be made 24 hours before installation of home and request for inspection.
This form must be completed and signed by the Park Manager. This completed form is required at the time
of application for all building permits.
JOB SITE ADDRESS:
MANUFACTURED HOME PARK:
INSTALLER INFORMATION:
NAME OF OWNER OR CONTRACTOR DOING WORK:
PHONE: _____ CONTR STATE LICENSE #:
STREET ADDRESS: CITY: ZIP:
MANUFACTURED HOME INFORMATION:
MANUFACTURER: YEAR HOME WAS MANUF.:
YEAR OF SEAL: SERIAL #:
DIMENSIONS OF HOME: DIMENSIONS OF LOT:
ARE THERE ANY ROOM ADDITIONS, PORCHES, DECKS OR ACCESSORY BUILDINGS?
YES NO IF YES, STATE TYPE AND SIZE:
I HEREBY AGREE THE INFORMATION ABOVE IS COMPLETE AND ACCURATE. I HAVE PERSONALLY
INSPECTED THE SITE AND THE HOUSE PAD FOR COMPLIANCE WITH ALL CITY ORDINANCES AND THE
MINNESOTA STATE BUILDING CODE.
PARK MANAGER’S SIGNATURE: DATE:
SITE PLAN MUST BE SHOWN ON REVERSE SIDE. INCLUDE ALL ADDITIONS, ACCESSORY BUILDINGS,
DISTANCES FROM LOT LINES, EASEMENTS AND ADJOINING HOMES.
OFFICE USE
APPROVED BY: DATE
COMMENTS
(REVISED 12/28/2017)
16962 Kenrick Ave #9
Connelly Community
RVWP, LLC
651-373-6137 MI753338
6770 Stillwater Blvd N STE 110 Stillwater 55082
MidCountry 2024
2024 TBD
16x60 See Site Plan
4/17/24