HomeMy WebLinkAboutBuilding 05-0970
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
tJ. .r().o5
I White
Pink
Yellow
File
City
Applicant
PERMIT NO. OS: 0970
LA/i/e
ZONING (office use)
1116 ~L)U=; wooO
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDz,S. ZJ5. 0/9.0
OWNER
(Name)
'it c:. Qc... -\
'9 lQ , l -"'2 ......::J
(Phone) G\ 5'1- '-\'-\ ~ ~ S,-\ (e,
(Address)
BUILDER
(Company Name)
(Contact Name)
~-\~c.L~CV~
~~\-
.-.c..-
TYPE OF WORK 0 New Construction ODeck OPorch
OAddition OAlteration OUtility Conn
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
(Phone) <A 52 '-\1.\1 <1(D~<6
(Phone)
~ "v "'):
e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
o Misc,
B
S U
PROJECT COST IV ALUE
(excluding land)
$
I hereby certify that I have nlrOlshed mfmmation on this application which IS to the best of my knowledge true and correct. I also certify that I am the owner m authonzed agent Ill1' the
above-mentlOned properry and that all construction will conform to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this permit for Just cause Furthe' ore, I hereby agree that the Clry official or a designee may enter upon the propeny to perform needed mspectlons
x
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
l3uildtllg Onieial
Date
~o ~~-t oCS
Contractor's License No, ate
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 $
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 TIllS document
when signed by the City Planner constItutes a temporary Certificate of ZOnIng compliance and allllws constructllln to commence, Before occupancy, a CertIficate of Occupancy must be
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