HomeMy WebLinkAboutNo 14394 ~ 143=`4
Valuation ~ a.s.'+'};: Water Unit t' .E~ „{i,u+
C,It}/OfLak@Vl~~e BIdg.PermitFee. Sewer Unit ~.~Ci:•(~4'
State Surcharge S~I Area .
Metro SAC Charge ~ ^ = ~ ' Park Fee . '
BUILDING PERMIT Other..:.a..;.....~'..:. '.w TOTAL PAID........^~rr'•~~i6.~.~~1
& Receipt
Permission is hereby granted to ri..t-?i-~~_ C~'~i~.t?~~;~E.,::+ir~
r s .t~ ~
Building on Lot Na" Block ~ Subdivisiori'`~~'~~~ ~#1.~ +iu:k
Parcel No. .?2-~dl~zti~?--~, ~)t~pl~~
i
in theClTY OF LAKEVILLEtobeusedas 1aT'i`71 `~;L~u+:.L
j This permit is issued on the expressconditonthatthe ~ 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
III the State of Minnesota pertaining to the construction of buildings.
Street Address i i~~ I,? e1_ i:E~.;~l,~ ~ Kr? r:~r
Director, License and Inspection
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Calffor inspections.-.469-4431. gy ~ '~~-a`-"".°_' ~
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$UILDING PERMIT APPLICATION
ONE AND TWO FAMILY RESIDENTIAL
CITY OF LAKEVILLE
INSPECTION DEPARTMENT
8747 .208TH STREET W.
P.0. BOX. 957
LAKEVILLE,..MN 55044
469-4431
DATE :
6F-
JOB SITE ADDRESS: ~
LEGAL DESCRIPTION: LOT:~~j BLOCK: c~ SUBDIVISION OR SECTION;
OWNER: ~ 1`~ C7~.L PHONE :
STREET ADDRESS : (~j ~C~ ~ CITY : IP : X57
CONTRACTOR: PHONE: _
STREET ADDRESS:. ~i.~~ ~ CITY: i~)~•.~9-!~`1L1y~;~ ZIP:
.CLASS OF WORK: NEW: ADDITION: ALTER/REMODEL: DEMOLISH:
i PROPOSED USE (DESCRIBE IN DETAIL):.
' ~ ~
i
VALUATION OF WORK (EXCLUDING LAND): "~~,o (p p
I HEREBY APPLY FOR A BUILDING PERMIT AND I ACKNOWLEDGE THAT THE INFOR?'KATION
ABOVE IS COMPLETE
AND ACCURA
TE THAT
THE WO
RK WILL BE IN CONFORMANCE WITH Q~~
.THE ORDINANCES AND CODES OF THE CITY AND WITH THE~STATE BUILDING CODE; THAT d"`^~) ~{j
I UNDERSTAND THIS IS NOT A PERMIT AND WORK IS NOT TO START WITHOUT A PERMIT;
i AND THAT THE WORK WILL BE IN ACCORDANCE WITH T
HE APPROVED PLAN..
i Applicant's Signature: FOR CITY USE ONLY err ~ ;
~ .
te: ~ Zone v
a; 3.3~)
P rm'
e it Fee $ ,s .~~"j~
I Plan Check $ ~ ~~p - 6~-
Bui din O~f'cial 's S
g i n
ature:
Surcharge $ 3S
I ~ -
Date: -c~s
SAC $ 5aS -
Coumments • _
- - - - - - S/W Units $ oZS
Sewer Area $ ~a~ ~
Park or Misc. $
TOTAL DUE $ -s~v-_
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