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MANUFACTURED HOME PARK MANAGER APPROVAL <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2401 MOUNDS VIEW BLVD. — MOUNDS VIEW, MINNESOTA .' 5112-1499 <br />(763) 717-4020 -- FAX (763) 717-4019 sounds- iewv.ms.us <br />This form must be completed and signed by the Park Manager. This completed form is required <br />at the time of application for building peen it. (For mobile home installation permits: application <br />must be made at least 24 hours before installation of home and request for inspection.) <br />JOB SITE ADDRESS: 5109, Cakoo+ Or, Rtw (d S V ) <br />DESCRIBE WORK: cc— o - S1--aV r5 6-1-4 o i 4 ; 2:) (o,u.. S+i"r'S <br />CONTRACTOR OR INSTALLER INFORMATION (i 'applicable): <br />NAME OF OWNER OR CONTRACTOR DOING WORK: <br />OWNER: <br />CONTRACTOR: 'o-kc.4 -1►�l,,b rti Su )u+TzrS <br />ADDRESS: I t. 6 R c). 81 CITY: MA yk . Cir t„ L STATE:-ln_ZIP: <br />STATE LICENSE # $C, i tt -iSo PHONE:6 J 7Zc- 3u CO FAX: <br />MANUFACTURED HOME INFORMATION (required for mobile home "limn): <br />): <br />YEAR: <br />MANUFACTURER <br />YEAR OF STATE SEAL: SERIAL #: <br />DIMENSIONS OF LOT: ARE THERE <br />PORCHES, DECKS OR ACCESSORY BUILDINGS? <br />TYPE AND SIZE: <br />ROOM ADDITIONS, <br />IF YES, DESCRIBE <br />I hereby agree the information above is complete and accurate. I have personally <br />inspected the site and the house pad for compliance with all city ordinance. <br />PARKMANAGE —S SIGNATURE: (,c.,n-� C DATE: I 27 If <br />PRINT NAME: v 1 L <br />SITE PLAN MUST ACCOMPANY APPLICATION. PLEASE INCLUDE ANY <br />ADDITIONS, ACCESSORY BUILDINGS, DECKS AND SHOW DISTANCES FROM <br />LOT LINES AND FROM ADJOINING HOMES AND EASEMENT. <br />