HomeMy WebLinkAboutBuilding 05-0975
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
tt3()~CJe)
File
City
Applicant
I PERMIT NO. 05- 0915' I
1 White
Pink
] Yellow
/59tJ/ ~tJlV/
AVe
ZONING (office usc)
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
PID zs: ~ ()/O. 0
BLOCK
~'::~R S'hCUv{V I<fJV\t-Jon
(Phone) '75).. d.). (;, '-I co- -7-
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) fft) S3>
(Phone) Gs f ~ 75>-- 3d1"I
(Phone)
.5-
TYPE OF WORK 0 New Construction ODeck o Porch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
o Misc.
III IV V
HIM
2 3 4
A
R
5
B
S
I
E
II
F
I
U
PROJECT COST IV ALUE $
(excluding land)
x
I hereby certily that I have fllrnlshed mformation on this applicatIOn which IS to the best of my knowledge true and correct. I also certifY that I am the owner or authonze,i agent for the
above-mentIOned property and that all Cllnstruction will conform to all eXisting state and local laws and will proceed m accordance with submitted plans I am aware that the buildmg
official can rev, e thIS permit r Just cau nthelmOle, I heleby agree that the City offiCial or" deSignee may enter upon the plOpClty to pel form needed mspectHlns
- ~ok~
Signature Contractor's Ltcense No ckte
Permit Valuation
Permit Fee
Park Support Fee
SAC
#
#
$
$
$
$
$
$
I $
$
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
#
#
Water Tower Fee
Builder's Deposit
Other !
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
TOTAL DUE
This Application Becomes Your Building Permit When Approved
c,J
Buildilll! Ol1icial
Date
$
$
$
$
$
$
$
$
$
ThIS IS to certifY that the request in the above applical10n and accompanymg documents is in accordance with the City Zoning Ordinanc d may proceed as requested. Tills document
when signed by the City Planner constItutes a temporaty Certificate of Zonmg compliance and allows constructIOn to commence. Before occupancy, a Certificate of Occupancy must be
issued
Planning Director
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any