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2. Contractor's License Number
3. Date
   Date
5. House Number
   All Excelsior addresses are 3 digits or less. If your house number is greater than 999, it is not within Excelsior city limits. Please call 952-474-5233 for assistance.
6. Street Name
8. Address Line 2
9. Zip Code
13. Legal Description Property ID Number
15. Section
16. Lot
17. Block
19. Addition
20. Plat Number
21. Parcel Number
25. Owner's Name
26. Address
27. Telephone Number
29. Architect's Name
30. Address
31. Telephone Number
33. Builder's Name
34. Address
35. Telephone Number
39. Type of Work

    1. Fireplace
    2. Septic
    3. Heating
    4. Plumbing
    5. Reroofing

    1. New Construction
    2. Alterations
    3. Addition
    4. Finish Basement
    5. Residing

    1. Deck
    2. Porch
    3. Garage
    4. Chimney
    5. Misc. / Other
40. Misc. / Other
44. Estimated Value
46. Front Yard Set Back from property (in ft)
47. Rear Yard Set Back (in ft)
49. Side Yards Set Back - Right Side:
50. Side Yards Set Back - Left Side:
54. Miscellaneous - Please Describe the Proposed Project
56. Special Conditions

    1. It is my responsibility to locate and establish the elevations if needed of all site improvements. Required adjustments at my expense.
58. Acknowledgement & Signature
    The undersigned hereby agrees that, in case such permit is granted, that all work which shall be done and all materials which shall be used shall comply with the plans and specifications herewith submitted and will all the ordinances of said City of Excelsior applicable thereto.
60. Signature of Applicant
62. Additional Documentation
    Please send additional documentation and plans via email to Pat Smith.
Leave This Blank:


87. 1. Receive an email copy of this form.
88. Email address

    This field is not part of the form submission.

89. Submit Submit and Print

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