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Building Permit Application <br />City of Gem Lake, Minnesota <br />4200 Otter bake Road, Gem Lake,MN 55110 <br />6517.47=2790192 — fax 651747-2795 <br />cityC kemlakemn-org <br />Property owner:Siteaddress. <br />Owner phone/cell:. <br />'- - ":3C.��. email: <br />Contractor: <br />State license # <br />Address: <br />City/State/zip. <br />Phone c and/or other: <br />ell an �:.•�_ �: _ ;. <br />i <br />All general contractors and all sub -contractors Performing. wark in connection with this <br />building perariit are required to be Iicensed by the State of 2M7inne: wta or the City of •Gesn Lake, <br />Property type: Commercial ❑ Multi -family ❑ Single.Family ❑ Townhome <br />Construction type: ❑ :Addition. ❑ Demolition .' New ❑ Remodel <br />`ype ofpermit: check all that apply) <br />Accessory bldg. Addition 13athrcom remodel Deck Demo <br />Excavating % Grading Kitchen remodel New: construction IZdofii <br />Siding Swng pool Window Wood-burmmgInsert. Other <br />�ype of (zoning) permit: check all that apply) <br />Access:bldg. iirnited tsrn.) Drive A Ferice Impervious Patio Tani <br />Briefly describe work: <br />Estimated Valuation of Work: $.'2L('t-�, .��=-� <br />I hereby.apply far a building permit and acknowledge that the information above is completeand acourate;.that oil. <br />work shall be in conformance with the: City of Gem Lake ordinances and the State of -Minnesota Building Cone. I <br />acknowledge that building: permits issued in the City of.Gcm Lake shall. become nult and void. if permitted work does <br />not:commence within 180 days of issuance, nr if permitted uaor-k is suspended:or abandoned for TSQ :dam. <br />Applicant Signature: - '? ± Date: 6 <br />For office use. only: Permit number: <br />Zoriin5 District: Reviewed ry:. Date: <br />Bull ding Occupancy use: Type.of Construction: Approved by: Date: <br />Applicant cmlfactedlperriiitconipleted: <br />