HomeMy WebLinkAboutNo 12365 1
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City of Lakeville
INSPECTION DEPARTMENT
BUILDING PERMIT Valuation
8t ReCel'pt Building Permit Fee ~ ~ . K~
State Surcharge .
TOTAL FEE PAID iC}.
Pertt~ssion is heFeby granted to .,Tt.. ~ ~ t'e~~ T':'~ ~x ~ rs ~,t,;~ t~Fy*~~ z'
Building op Lot No. Block ~ `I Subdivision Tyr-r, trg3 '1 s~+a,-~r ~r~, 6,~ ry
Parcel u ~ '~s1is--_~ r.: Plat
. in ih~GITY OF 1.AKEVILLE to be used as ~ ` ~ t"~"~" at f ~ ~ v 1 i
~
This.permit?is is;3tFed on the express condition that the -ERECTION' ~ eLTERATION -REPAIRS
• j,,e
~~-ENLARGEi~ENT MOVING -DEMOLITION respects to the statements certified to in the application for
such ~germi#, and Ehat alf work shall be done in accordance with the Ordinance of LAKEVILLE, Minnesota and the State of Minnesota
pertaining to the construction of buildings.
Street Address ].h }_<3 ~'~*~t~~~ f~.~~.rttkc~ ~3~.~~.:I.~m°
. Director, License and Inspection
Attention is particularly called to the .cutting up of streets making main sewer
connections, driveways and curbs. ObtainpermitforsuchconstructionfromtheClTY ~ /
OF LAKEVILLE. _Inspection Department Not Responsible For Any Damages to Sy f ' `
Public Utilities.
M
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1 ~ APPLICATION FOR BUILDING p~tMIT CITY OF LAKEVIZLE
8747 208th St. W., P.O.Box 957
. Lakeville,. MN 55044
(612) 469-4431
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Job Site
Ad
.dress ~ Z`-3-~ ti`T,~}SiA vc [K~~.ioc~rv~" -
,tic
~ ~
Legal Description: Lot Z.~ Block iC~ Addition ~ ~ki,,~t('~
1
v~~~Y
y ~ •
14 5' ~ ~ `7r/~, lA~ i l
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Owner ~=_t'cY Z.n~~`~
N ~ ~~.J.C~~~~/L Phone - ,3/G~ 7
Address S~ Mc P.O.Box:
City Zip
. Contractor ~ ~Lc;~I~e~~C Phone
Address ~ P.O.Box:
City Zip
Class of Work: Erect ( ) Alter ( ) Repair ( ) Enlarge ( ) *Sove
( ) Demolish
Froposed Use (Describe in Detail) ~ni~S~-{ ~,.,;;,,;5;
A ~S ~r ,~~.,,3 ~ ;
YC~
~ 9~G~Ui'VC ~hi~ ~GIZ) i 2 E..9 J r J/ S
l~~=t~
Commercial: Square Feet ~ Employees
Heating Contractor
Plumbing Contractor
Sewer & Water Contractor
Electrical Contractor
Special Conditions
Valuation of Work: $ /-~j `gyp mac'
FOR CIT° USE ONLY
.Si tore of Applicant ~ Title:
City Fee $ _ , `jam
Plan Check $
Date Surcharge $ ~ • ~
~ ,r
t=
SAC ~ $
Signature of Zoniag Officer:
• S/W IInits $ •
Date. Sewer Area $
Signature of Building Official: Street Area $
Park or Misc. $
Total $ ~ ~C~
Date:
SID MILLER, BUIZDI+IG INSPECTOR
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