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Valuation ~ ~ ~ Water Unit j
Cilt~/ Of. Lak@VI~~2 Bldg. Permit Fee ~ • Sewer Unit
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State Surcharge ....v~;~ ~ftArea .:a,-~t~:. f~€~ ~•:j
Metro SAC Charge ~.3 r :'.3'~ Park Fee .
$UILDING PERMIT Other: .........agc,.... TOTAL PAID.........' "fir
Receipt
Permission is hereby granted to ~ • - •t;,~:i 1C = ~ . ' • .
Building on Lot No. Bloci~ Subdivision ~~t°y~_ ~'=~"-'t~~"
Parcel No. %,!°°.~-tk~sl>~-C34^._,.i2
in the CITY OF LAKEVILLE to be used as ~ek'~t-~ t'' ~ ~ ` ~ ;~i~t ~ ~-Y ~W~ Z ~ ~t t1
This permit is issued on the expressconditionthatthe ~i ERECTION ALTERATION REPAIRS
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~ ENLARGEMENT .MOVING DEMOLITION respects to the statements certified to in the
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application"for such permit, and that all work shall be done in accordance ,with the Ordinance of LAKEVfLLE, Minnesota and
the State of Minnesota pertaining to the construction of buildings.
Street Address I~SI~sv k.~.~;a:E.. _ ,y-. T$~e'i~xj:;. ~:?:i ,~A ;«`'~`~t';r:,
Director, License and Inspection
Callforinspections - 469-4431. By
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BUILDING PERMIT APPLICATION
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ONE AND TWO FAMILY RESIDENTIAL
CITY OF LAKEVILLE
INSPECTION DEPARTMENT
8747 208TH STREET W.
P.O. BOX 957
LAKEVILLE, MN 55044
469-4431
DATE ~ ~ by+' G ~ ~ " 7
JOB SITE ADDRESS: V ~ ~ A r - 1 !L.~
LEGAL DESCRIPTION: LOT: BLOCK: SUBDIVISION OR SECT ION:~~~ ~~"~H !S,^
OWNER: ~vv~~ /3~~ ~ ~~'''"`S PHONE:
STREET ADDRESS: CITY: ZIP:
CONTRACTOR: ~ ~ Yo~~ /3 ~ t ~1'~-+~ rF^h PHONE: 5~~1 a 7 ~ 7 S"
STREET ADDRESS: 0'~ CITY: ~~-6r'`J o`er ZIP: ~
CLASS OF WORK: NEW: ~ ADDITION: ALTER/REMODEL: ~yDEMOLISH:
PROPOSED USE (DESCRIBE IN DETAIL) : xcYl~
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~5~~~ ~f'~ ~ ~
VALUATION OF WORK (EXCLUDING LAND): ~~'~~y'`~~~__
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.
A licant's Sin re: FOR CITY USE ONLY
~ ~ Date:~O~? Zone
Permit Fee $ '7~
-Plan Check $ ~ ~ c~--~
wilding Of~^i~ial 'signature:
urcharge $ ~
Date: ~ .
a
SAC $
Comments:
S/W Units $ / y
Sewer Area $
Park or Misc. $
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TOTAL DUE $ ~ ~ ~ O~