HomeMy WebLinkAboutBuilding 05-1086
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
Date Rec' d
White
Pink
Yellow
I PERMIT NO.OS- 1t't'01
File
City
Applicant
/Jl3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ~ADDITION
~C01 d
OWNE~
(Name) . rY\;f\\'L
<;;il E n...
(Address)
l'i 3-'\ 4 ~ e...v Au.
NtS
BUILDER
(Company Name)
(Contact Name)
(Address)
~~"f'"\C
ZONING (office use)
I'
aKi
PID
;0 cYVn-te;
C>
(Phone)
~Sl-sa,~ t"J'i ~~
(Phone)
(Phone)
TYPE OF WORK 0 New Construction DDeck DPorch '~Re.Roofing
DAddition DAlteration DUtility Connec't\on
~e-Siding DLower Level Finish 0 Fireplace
~tud ~
CODE: DI.R.C. DI.B.c. o Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5
PROJECT COST /V ALUE $
(excluding land)
I hereby certity that I have Iurnlshed lOformation on this applicatIOn which is to the best of my knowledge true and correct. I also certIfy that I am the owner or authollzed agent I'll" the
above-mentIOned property and that all construction will conform to allexistlOg state and local laws and will proceed in accordance with submitted plans I am aware that the blllldlOg
official can revoke this permIt for Just cause Furthermore, I hereby agree that the CIty official or a deSignee may enter upon the properry to perform needed lOspectlllns.
x
Signature
Contractor's License No.
Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $.
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace PermIt Fee $
This Application Becomes Your Building Permit When Approved
l:3uildll1g OffiCial
Date
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&.-
~~ --- g:p --
b.- -6
I ~~~()5 06---1
Paid
Date
ThiS IS to certify that thc request In the above applicatIOn and accompanYlOg documents IS 10 accordance with the City Zoning Ordinance and may proceed as requcsted Tim document
when signed by the City Planner constItutes a temporaty Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certlticate of Occupancy must be
Jssucd
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