HomeMy WebLinkAboutNO 14249 19
Valuation Water Unit
City of Lakevi I le Bldg. Permit Fee Sewer Unit .
State Surcharge Street Area .
Metro SAC Charge Park Fee .
BUILDING PERMIT Other TOTAL PAID.........
& Receipt
Permission is hereby granted to
Building on Lot No. Block Subdivision -
Parcel No.
in the CITY OF LAKEVILLE to be used as '
This permit is issued on the express condition that the ERECTION ALTERATION REPAIRS
ENLARGEMENT MOVING DEMOLITION respects to the statements certified to in the
application for such permit, and that all work shall be done in accordance with the Ordinance of LAKEVILLE, Minnesota and
the State of Minnesota pertaining to the construction of buildings.
Street Address
Director, License and Inspection
Callforinspections - 469-4431. BY '
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BUILDING PERMIT APPLICATION
ONE AND TWO FAMILY RESIDENTIAL
CITY OF LAKEVILLE
INSPECTION DEPARTMENT
8747 208TH STREET W.
P.O. BOX 957
LAKEVILLE, MN 55044
469-4431
DATE : - _ S
JOB SITE ADDRESS: ' ,~d(~ f~
LEGAL DESICR''IPTION: LOT: BLOCK: SUBDIVISION OR SECTION;
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OWNER: rl S ~ I,1-~! c° UL's PHONE: ~~U ` r Y'h
STREET ADDRESS: f
L7/ ~ r~~ ~ r~ CITY: Y! ~ ZIP : S" `r ,,r
CONTRACTOR: PHONE:
STREET ADDRESS: CITY: ZIP:
CLASS OF WORK: NEW: ADDITION: ALTER/REMODEL: DEMOLISH:
PROPOSED USE (DESCRIBE IN DETAIL) : ~ ~s ~ C~'
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VALUATION OF WORK (EXCLUDING LAND) : t % G L~ C.~, Ci
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.
Applicant's Signature: FOR CITY USE ONLY
Date: Zone
Permit Fee $ i ~
Plan Check $
Buil ing Official 's Signature:
p' Surcharge $ C ~ ~
Date: ~0
SAC $
Co_mm_ent_s_: _
S/W Units $
Sewer Area $
Park or Misc. $
TOTAL DUE $ ' ~ ~