BUILDING PERMIT APPLICATION
COMMERCIAL AND INDUSTRIAL
CONSTRUCTION
CITY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE
LAKEVILLE, MN 55044
952-985-4440
Office Use Only
___________________
Permit Number
___________________
Received By
___________________
Date Received
___________________
Fee Total
JOB SITE ADDRESS: __________________________________________SUITE# __________________
SITE BUSINESS NAME: _________________________________________________________________
LEGAL DESCRIPTION: LOT _____ BLOCK_____ SUBDIVISION: ______________________________
APPLICANT: _______________________________ EMAIL: ___________________________________
OFFICE PHONE: ________________CELL PHONE: ___________________FAX: __________________
STREET ADDRESS: ___________________________CITY:_______________ ST: _____ZIP: _________
CONTRACTOR: ____________________________ EMAIL: ___________________________________
OFFICE PHONE: ________________CELL PHONE: ___________________FAX: __________________
STREET ADDRESS: ___________________________CITY:_______________ ST: _____ZIP: _________
ARCHITECT: ____________________________________ LICENSE#: _____________
CIVIL ENGINEER: ________________________________ LICENSE#: _____________
STRUCTURAL ENGINEER: ________________________ LICENSE#: _____________
MECHANICAL ENGINEER: ________________________ LICENSE#: _____________
ELECTRICAL ENGINEER: _________________________ LICENSE#: _____________
VALUATION OF WORK (excluding land): ____________________ SQUARE FOOT ________________
IS BUILDING SPRINKLED? _________________________ STANDPIPES? _______________________
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.
NAME OF APPLICANT (Please Print) _____
APPLICANT’S SIGNATURE: ___________________________________DATE: __________________
www.lakevillemn.gov
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PROPOSED USE (Describe in Detail):
COMMERCIAL & INDUSTRIAL BUILDING PERMIT APPLICATION PAGE 2
OFFICE USE ONLY
BUILDING PERMIT TYPE: CODE INFORMATION
Apartment Building
Commercial Bldg – New
Commercial Bldg – Add/Remodel
Industrial Bldg – New
Industrial Bldg – Add/Remodel
Tax Exempt Bldg – Add/Remodel
Tax Exempt Bldg – New
Commercial Re-roof/Reside
Retaining Wall
Buildings Moved
Buildings Demolished
Footing/Foundation Only
Grading
Miscellaneous
VALUATION: $ REQUIRED INSPECTIONS:
PERMIT FEES: FOOTING
PERMIT FEE: $ FOUNDATION
PLAN CHECK $ FRAMING
STATE SURCHARGE $ INSULATION
M.C.E.S. SAC UNIT (___) $ FIREPLACE
WATERMAIN UNIT (___) $ SITE
SANITARY SEWER UNIT (___) $ OTHER
SANITARY SAC UNIT (___) $ BUILDING FINAL
ESCROWS $
OTHER $
TOTAL FEES: $
APPROVALS:
PLANNING or CED DIRECTOR: DATE:
CITY ENGR or ASSIST CITY ENGR: DATE:
FIRE MARSHAL: DATE
BUILDING OFFICIAL: DATE:
IBC Occupancy Group
Type of Construction
Fire Suppression System
Zoning District
Code Edition
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COMMENTS:
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