HomeMy WebLinkAboutNo 12171 r~ 1. Y A.x~a°i1. 5, ,19$4
" ~ " City of Lakeville
sr~w INSPECTION DEPARTMENT j
7~{J.Ot3 Taz~c~r ;S~At. ~'c~.BUILDINC PERMIT Yatuatiort
3r:~wer ir:hit' Frio Building Permit Fee"„ ~A3~~U
& Receipt
Z ~ , Caf3 Se n=~ r ~s ~Te~ , State Surcharge .
TOTAL FEE PAID ~
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Permission is hereby granted to ~ ' ~ { r` ~ i-
Building: on Lot. No. 2'~ Block-~- Subdivision ~nr?asvm t datizt-
:Marcel ~ 22,-aI~:77...2~:~A.1G Plat
~ in the CITY OR' LAKEYILLf to be used as t' ~'~,~~r*`4i~r~ ~ a
`
This permit ispssued on the express condition that the '-ERECTION . -JILTERATIOM - -JiEPAiRS
F
_~NLARGfMENT _JNIOYING --DEMOLITIONYespectt: to the statements certified to irk the application for
G such permit, ,and that ait work shall be done in accordance with the Ordinance of LAKEYILLE, Minnesota and the State of `Minnesota
pertaining to the construction of buildings.,
~r F~~*~s~.~ A~»zaae ~ ~iiZl~r
Street Address ~ `
E Director, }.icense and Inspection
Attention is particularly called to the cutting up of streets, making maip sewer.: ~
connections, driveways and curbs. ObtainpermitfiorsuchconstructionfromtheClTY f ~ `
OF LAKEVILLE. Inspection Department Not. Responsible For: Any Damages tp By ~
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Public Utilities. w
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~ + § APPLICATION FOR BUILDING PERMIT
/i K r'" CITY OF LAKEVILLE
1~ 8747 208th St. W. P.O. Box M
..Lakeville, MN 55044
469 -4431
.Job Site Address: ~ mss'
Legal Description: Lot ~ % Block « Addition '
Owner Phone
Address
Contractor _ Phone
Address x ~ >
Class of Work : Erect ( )Alter ( )Repair ( )Enlarge O Move ( ) Demolish
Proposed Use (Desc\ribe in Detail) ~
Heating Contractor
Plumbing Contractor
Sewer & Water Contractor
M
Electrical Contractor
Y
Special Conditions
Valuation of Work: $ ~~J~7; ~;>j~ 4 ~ ra
Signature of Applicant & Title: FOR CYTY USE ONLY -
Zone
r City Fee $
Dat Plan Check
Signature of Zoning Officer: Surcharge $ ~ `f ~'u'"'°"
SAC S ~ ~`S ~
Hook-ups a,~
Date
Area Charge $ c~ ~r'r
Signature of Building Inspector:
Other
Total $ c~'r ~'j ` c~f
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