HomeMy WebLinkAboutNo 14399 ~ Valuation ' ~ < E ~ Water Unit ~ G.i~ .
Clty Of Lak@VI II@ Bldg. Permit Fee . ¢ - Sewer Unit ~ •
State Surcharge , - 3 Area . ~~~WC~`... ~'S~~ . ~~i'
Metro SAC Charge ~ s • Park Fee .
BUILDING PERMIT Other...'..>:..~.t~;c.c. - TOTAL PAID...:.....4s:,i~i~3.`i,~
` & Receip#
Permission is herebygranted to ~ t'i~.
~y~~i%L~ ~a'~.' _E wY'L'. t~+~~t
Building on Lot Np. Block Subdivision
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in theClTY OF LAKEVILLEtobeusedas ~'x'"j i', ~ ° { ' ~ , F ~ `~Y
fhispermitisissuedontheexpressconditionthatthe 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 1AKEVILLE, Minnesota and
the State pf Minnesota pertaining to the construction of buildings.
Street Address ,,f ~ ta'y" :i~~.f.._. ' ~
Director, License and Inspection
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Call for inspections - 469-4431. By ~ ' - ~ ~ ' ~ ~ F
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BUILDING PERMIT APPLICATION ~ R
ONE AND TWO FAMILY RESIDENTIAL ~
CITY OF LAKEVILLE
INSPECTION DEPARTMENT
8747 208TH STREET W.
P.O. BOX 957
LAKEVILLE, MN 55044
469-4431 ~ r'
DATE : 4~j~~~/ ~ / D
JOB SITE ADDRESS: _
LEGAL DESCRIPTION: LOT: BLOCK: SUBDIVISION OR SECTI ; ~v0~ / tJ~
OWNER : ~
STREET ADDRESS: ~ d~ CIT ~~/~e~Jl1~ ZIP:
CONTRACTOR : S 5~ K r1 PHONE
STREET ADDRESS: CITY: ZIP:
CLASS OF WORK: NEW: ADDITION: ALTER/REM/O~DEL: DEMOLISH:
PROPOSED USE (DESCRIBE IN DETAIL): / T ~
VALUATION OF WORK (EXCLUDING LAND): ~ ~ ~ ~ U
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
~/y~~~~~! -6~ ~ ~d Date: f Zone
Permit Fee $ ~ 5~•
Plan Check $ ~ ~ •
Buil ing Offic'a 's Signature: ^
i ~ pp Surcharge $ o~Q
Date: ~`3-U~
SAC $ c~~~• 01~
Comment s_: _
S/W Units $ ~"•r~S •
Sewer Area $ S~ • -
~ Park or Misc. $
TOTAL DUE $
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