HomeMy WebLinkAboutBuilding 05-0639
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
'1 ~t. oS-
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(Please
ADDRESS
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1 White
Pink
Yellow
File
City
Applicant
\ PERMIT NO. 0.5". 0(,3'1\
ZONING (otT1ce use)
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LEGAL DESCRIPTION (office use only)
I is-: 00 f-~ ()
LOT
BLOCK
ADDITION
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PID ",.1 .
OWNER
(Name)
J '^-l/-L P.' l- ( (L
(Phone) (p 51 "? '11 3311
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
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P~J<r
F('~t-~ ~~M'''''
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S ,x"L-H""-Pw'--
(Phone)
(Phone)
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TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Fimsh 0 FIreplace
DAddition DAlteration DUtility Connectlon
CODE: OI.R.C. OI.B.C. o Misc --------
Type of Construction: I II III IV V A B PROJECT COST /V ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certifY that I have hlrmshed mformatHln on this applicatlon which is to the best of my knowledge true and correct. I also certifY that I am the owner or authorIzcd agent for the
above-mentIoned property and that all constructlon will conform to all eXIstmg state and local laws and will proceed in accordance with submitted plans I am aware that the buildrng
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X .1'!-6lc:::- A,.~ _ 7 n r
Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee I $
Sewer & Water Permit Fee $
Gas Fireplace PermIt Fee $
This Application Becomes Your Building Permit When Approved
811ildln~ Otflcial
Datc
5"k Suppo" Pee # $
SAC # $
Water Meter SIze 5/8", I", $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ '7&.00
[Paid
L Date
'hIS IS tD certifY that thc request 10 the above applicatIon and accompanymg documents is 10 accordance with the City Zonmg Ordinance and may proceed as requcsted Tim document
'lcn signed by the City Planner constltutcs a temporary Certificate of Zonmg wmphance and allows constructlon to commence. Before occupancy, a Certltlcate llf Occupancy must be
'ed
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