HomeMy WebLinkAboutNo 14280 +
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Valuation- ~~,y' l,,,,.; Water Unit oi_.,,~,f
Clty Of LakeVl (l@ Bldg. Permit Fee ~ ~ ' ''j Sewer unit - ' } • fly
State Surcharge i~ . ~t Area .t'~: , , ~ • ,-t
Metro SAC Charge ~z ~ ~ • Park Fee .
BUILDING PERMIT Otner... y~~'t~r~ ~~',~.tr~ TOTALpA1D....... sr?¢S~~_]s1
& Receipt..
Permission is hereby granted to Bt:3. ~ ~ ~ `
Building on Lot No. Block ~ Subdivision )~'~lt~ ' t ~ ~:z
Parcel No, ~~°2t~^~fs`~}--tl~'~-~
in theClTY OF LAKEVILL`Etobeusedas t~ ~`~s'~eL`~'a.cCt: ~t~¢~I~ f~.r~t"`Vf :iC~*~~iit'q
This permit is issued on the expressconditionthatthe ERECTION ALTERATION REPAIRS
ENLARGEMLAIT 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.
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Street Address
I[ Director, License and Inspection
! Callforinspections-469-4431. By t +-i`!"t'~'~ i,;' ~ i~rj~,
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BUILDING PERMIT APPLICATION
ONE AND TWO FAMILY RESIDENTIAL
CITY OF LAKEVILLE H
INSPECTION DEPARTMENT
8747 208TH STREET W.
P.0. BOX 957
LAKEVILLE, MN 55044
469-4431
DATE : ~ ~ ~ k
JOB SITE ADDRESS.: ~ L1 - ~~C~?~~1 ~
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LEGAL DESCRIPTION: LOT: ~ BLOCK: ~SUBDI~ ON OR SECTI0N:~0~~~~ ~ 7~-
OWNER: ~ ~ CY~0 t~ ~ G i r v S ~h ~ PHONE : " ~ 7 5~
STREET ADDRESS : / ~ ~ ~ CITY : L°. ~``U ~ ~ ZIP : 7 S 7 6 y
CONTRACTOR: ~ ~-~'o~x ~?jG ! ~.~rS ~h ~ PHONE:
STREET ADDRESS: CITY: ZIP:
.CLASS OF WORK: NEW: v ADDITION: ALTER/REMODEL: DEMOLISH:
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PROPOSED USE. (DESCRIBE IN DETAIL): SI~C,JJ`{ ~~~r~~y
VALUATION OF WORK (EXCLUDING LAND): ~
I HEREBY APPLY FOR A BUILDING PERMIT AND I ACKNOWLEDG 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.
plicant's Sign e: FOR CITY USE ONLY
Date: C~~ ~ Zone
Per it Fee $ ~~p
Plan Check $ e
Bui din Offici 's Si nature:
g g
Surcharge $ 02 • J~D
Date: ~ SAC $ ~
Comments_:_ j ~ Gli ~ ~ SN ft/ °u V12
S/W Units $ l 4as ~
Sewer Area $ o~ S~
Park or Misc. $
~ TOTAL DUE $ a sg~ .5'0 ~
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