HomeMy WebLinkAboutBuilding 05-0804
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
n at bottom)
It/3d-!
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Date Rec' d
I White
!link
Yellmv
File
City
Applicant
PERMIT NO. tJfF-
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(N ame)
(Address)
(Phone) d.53-- 33.3 ?
;1J
BUILDER
(Company Name)
(Contact Name)
(Address)
5~/f1,< ~
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAdditlOn OAlteration o Utility Connection
e-Siding OLower Level Finish 0 Fireplace
)E: OI.R.C. OLB.C. o Mise
.: of Constnlction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5 (excluding land)
x
I hereby certify that I have hlrmshed mftnmation on this appr ,tlOn which is to the best of my knowledge true and correct I also certify that 1 am the owner ()l authOrized agent tin the
JbovC-mcntlOJ1cd property and that all constru ti will co rm to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the huildmg
"nieiaI n rnuke 1 permll liJr JU' c use Ir lermore ereby agree that the CIty ufficial or a deSIgnee may enter upon the propelty to perform needed ms ectlon"
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 Pennit When Approved
l311ildltH! Oftielal
Date
I ThIS IS tu certify that the request III the above application and accompanymg documents is III accordance WIth the City Zunmg Ordmance and may proceed as requested TIllS ducument
! when signed by the City Planner constitutes a temporary Certificate of Zonmg compliance and allows construction to commence. Bcfure occupancy. a Certlficatc of Occupancy must be
I !5sued
L
Contractor's License No.
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other I $
TOTAL DUE $lte ---
~~'~
- I --~
~"'2-cJOI1
Paid
Date
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-91l50, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372