HomeMy WebLinkAboutBuilding 05-0815
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
/& ro3 L1jtJtJS
Date Rec' d
8.23. os-
I White
Pink
Yellav.
File
City
Applicant
I PERMIT NO. tJ s-. () 8 IS-I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER/) . ^
(Name) L h&..Y"'L~ 4- co...y~ L D('e!e~
(Address) le:, ((0 ~ L 0 ~~ E ~ C
(Phone)
9S)-4l/1-j7/5
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition OAlteration OUtility ConnectIon
e.Siding OLower Level Finish 0 Fireplace
CODE: OLR.C. OLB.C. o Mise.
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
I hereby certify Ihat I have furnished mfilrmalion on this application which is to the best of my knowledge true and correct. I also certIfy that I am the owner or authonzed agent hlr the
above-mentIOned property and that all cunstruction will conform to all eXlstmg statc and local laws and will proceed m accordance with submIlted plans. I am aware that the buildmg
offiCIal can revoke tlm pelmIt fOl Just cause FlIIthelmOle. I heleby aglee that the CIty offiCIal or a deSIgnee may enter upon the plOpel1y to pel form needed mspectlons
X C~-L 01V-- ~ r-~~-o~
SIgnature Contractor's LIcense No Date
Permit Valuation ?-, t>()(),O d
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbin Permit Fee $
g
1~"h,"',"1 ""mil Fee
I ~:e;i:;::e::r::l~::e
I $
I $
I $
This Application Becomes Your Building Permit When Approved
Buildln!! Ofticial
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
rpressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
'Builder's Deposit $
Other $
TOTAL DUE $ ?~. 00
.t.V
. . ). 7. cr-
ThIS LS to certify that the request in the above applicJtlon and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested. ThiS document
when signed by the City Planner cunstIlutes a temporary Certificate of Zonmg complIance and allows constructIOn to commence. Before occupancy. a CertIficate of Occupancy must be
I i\sucd
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