HomeMy WebLinkAboutLA108076 PERMIT
City of Lakeville Permit Type: Building
20195 Holyoke Ave Permit Number: LA108076
Lakeville, MN SSO44
(9S2) 985-4440 * L R 1 (C7 8 (l7 7 6
www.ci.lakeville.mn.us Date Issued: 09/18/2008
Site Address: 20450 Dodd Blvd
Lot: 006 Block: OOS Addition: Glenn Addition
PID: 22-30200-060-OS
Use: *22-3Q1z0(d-06QJ-05*
Description:
Sub Type: Reroof Construction Type:
Work Type: Replace
Description: Applicant must call for inspection.
Census Code: - Occupancy:
Zoning:
Square Feet: 0
Comments:
Fee Summary: Description Amount Revenue Code
Res Reroof/Reside/ Windows $39.50 1000-41 S 1
Surcharge (.SO) $O.SO 1000-2127
Total: $40.00
Contractor: Owner: -Applicant -
Eric Ruud
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO: (1) THE APPROVED PLANS &
SPECIFICATIONS; (2) THE APPLICABLE CITY ORDINANCES & CODES; AND (3) THE MN STATE BUILDING CODE.
Applicant/Permitee: Signature Issued By: Signature
e Use ly
RESIDENTIAL BUILDING
; ' PERMIT APPLICATION Permit Numb r
CITY OF LAKEVILLE
~.1-, BUILDING INSPECTIONS DEPARTMENT Received By
20195 HOLYOKE AVENUE
LAKEVILLE, MN 55044
952-985-4440 Date ]2eC~,
www.ci.lakeville.mn.us fir"{'
/ Fee Total
SITE ADDRESS: y ~ ~~At~l~ ~Ue~ Gi:~;
MAILING ADDRESS: CITY: ~tQ I~r~7 /~(,e~~,.~ STATE: ~%!/(Ij ZIP: ~
JOB DESCRIPTION: ~~-.r= _ d~
ESTIMATED VALUATION:~ac~d PROPOSED START DATE: 7 ~~S "Q~ END DATE: ~ ` z"`?'
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(New Residential Only): LEGAL DESCRIPTION: LOT: BLOCK: SUBDIVISION:
APPLICANT IS: ? RESIDE T O E ? CONTRACTOR
NEW MODEL HOME: ? YES L~,
10 IF YES -ADMINISTRATIVE PERMIT REQUIRED ISD #
PLE/A_SE FILL OUT THE FOLLOWING COMPLETELY
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NAME: ~I~c C- /~r~ u~
RESIDENT OWNER HOME PHONE CELL PHONE: ~lc~- +~Y.f~'- y~~
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GENERAL CONTRACTOR CONTRACTOR: LICENSE BC
? Homeowner OFFICE PHONE CELL PHONE:
? Contractor ADDRESS: CITY: ST: ZIP:
ELECTRICAL WORK CONTRACTOR: LICENSE CA
? Homeowner * OFFICE PHONE CELL PHONE:
? Contractor ADDRESS: CITY: ST: ZIP:
Single Meter on individual unit Meter Bank at end of building (Requires licensed electrician.)
PLUMBING WORK CONTRACTOR: LICENSE PM
? Homeowner OFFICE PHONE CELL PHONE:
? Contractor ADDRESS: CITY: ST: ZIP:
MECHANICAL WORK CONTRACTOR:
? Homeowner OFFICE PHONE CELL PHONE:
? Contractor ADDRESS: CITY: ST: ZIP:
SEWER/WATER CONTRACTOR NAME:
New Construction Only HOME PHONE CELL PHONE:
INTEREST EARNINGS ON THE ESCROW ACCOUNTS, IF ANY, ARE RETAINED BY THE CITY TO OFFSET THE
ADMINISTRATIVE COSTS ASSOCIATED WITH PROCESSING THE ESCROW APPLICATION AND REFUND. I HEREBY
APPLY FOR A BUILDING PERMIT AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND
ACCURATE; THAT THE WORK WILL B IN CONFORMANCE WITH THE ORDINANCES AND CODES OF THE CITY AND
WITHT 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
NAME OF APPLICANT (Please Prin ~f~fC ~uc.c z DATE C~a
APPLICANT'S SIGNATURE: