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Home My WebLink AboutLA226237-Permit AppRESIDENTIAL 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 Submit Application To: permits@lakevillemn.gov * *Entering your name affirms your intent to comply with the statement above. OFFICE PHONE #:_ OFFICE PHONE #:_ 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. Docusign Envelope ID: 241497D2-002D-4A88-8D59-F945343EADD8 X 8.2 KW PV ROOF MOUNT Surendra Nalla (732) 822-9074 X 8/5/2024 | 8:09 AM PDT Temecula 9060 179th St W , Lakeville, MN 55044 Freedom Forever MN, LLC Melissa Farias 9259043445 Business Pk dr CA X 503.560.5583 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