HomeMy WebLinkAboutBuilding 02-1079
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
8- ze -02-
I. White File
2 Pink City
J. Yellow Applicant
I PERMIT NO. 0 Z. "-/0 7;
ZONING (office use)
/C-/
e,,'I .../ E
Irlt-O~&..rJ
LEGAL DESCRIPTION (office use only)
LOT /Z-BLOCK I ADDITION
OC~e;l/D
PID 2S - ..?70 -Of? -0
OWNER 1) <<k
(Name) . (~ .
(Address) \ 1 \Cjo
c+.
(Phone)
g5d-4~-3'f I \
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
o Porch
ORe-Roofing
ORe-Siding
Deck
OLower Level Finish
o Fireplace
OAddition
o Alteration
o Misc.
PROJECT COST IV ALUE (excluding land) $
OUtility Connection
I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or
authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
;t~~r:to~form~:::IT1 2r-d3- 02
Signature Contractor's License No, Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
Park Support Fee
SAC
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer & Water Permit Fee
TOTAL DUE
I Paid IO~ -(3 b
Date ~ --- d
This
#
#
#
#
$
$
$
$
$
$
$
$
$
';
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
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