HomeMy WebLinkAboutBuilding 05-0977
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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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Pink
Yellow
File
City
Applicant
PERMIT NOt; 5 -0'77
tUc
ZONING (office lIse)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
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(Address)
(Phone)
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BUILDER
(Company Name)
(Contact Name)
(Address)
S~L
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ~e-Roofing ORe-Siding OLower Level Finish 0 Firepl'lCe
OAddition OAlteration OUtility ConnectIon
CODE: DI.R.C. DI.B.C. o Misc.
Type of Construction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
x
I hereby certify that I have hlrmshed mformatlOn on this apphcatlOn which IS to the best of my knowledge true and correct. I also eerlllY that I am the owner or authOrIzed agent filr the
above- entlOned property and that all construction will conform to all eXlstmg state and local laws and will proceed in accordance with submltted plans I am aware that thc buildmg
official ca evoke thiS permIt f~ Furthermorc, I hereby agree that the CIty official or a deslgnec may enter upon the property to perform needed mspectlons
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Signature Contractor's License No Date
Permit Valuation Z~t)O,t)O
Permit Fee $ -'L I. '7<:-
Plan Check Fee $ . ~
-
State Surcharge $ J.1-S
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
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, Date
Buildl11!! Ofticial
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 7" .00
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I Recei:t No. &bOll 0
By $r.
ThiS IS to certify that the request III the above apphcallon and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested TIllS document
when signed by the City Planner constItutes a temporary Certificate of Zoning compliance and allows construction to commence Before occupancy, a Ccrtltlcatc of Occupancy must he
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372