HomeMy WebLinkAboutBuilding 05-0768
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
lk '1/ {;
lu / L L c/ l4...}
Lit
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) r 4-I'Vl-C S
14 ~/tf6 Lc::l
( .
ILL. (/ ~YL/.
(Address) / ' C/O L.1-tJ
Date Rec' d
I White
Pink
Yellow
File
City
Applicant
PERMIT NO. OS- - 07"P-
ZONING (office use)
I
I ~ Cj
/
(Phone)
C' - 7 3 i / /
7~ :7-~~.-_ ~,.,4
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction oDeck oPorch Re-Roofing ORe-Siding DLower Level Finish 0 Fireplacc
oAdditlOn oAlteration o Utility Connection
CODE: OLR.C. OLB.C.
Type of Constmction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
o Misc
A
R
5
B
S
PROJECT COST IV ALUE
(excluding land)
$
U
I hereby certify that I have turmshed mformation on this application which is to the best of my knowledge true and correct. I also certIfy that I am the owner or authOrized agent for the
<lbnVC-mentlllned pruperty and that all CllnstruCtlon wIll contcJrm to all eXIstIng state and loeallaws and will proceed In accordance with submltted plans I am aware that the buildIng
(llfiClal ca levoke this pelnllt for Just cause FUlthclWOlC, I heleby agree that the City offiCial or a deSignee may enter upon the plopel1y to pel form needed inSpectIons
X ' ~L~t:7-- ~ ~{1j;L~ Y-r1-0,~
. Slgn~ "" Contractor's License No Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
i Penalty $
I Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
~~
BuildllH! OffICial
W910s
( D;{tc
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit $
Other $L
TOTAL DUE wtj (, .f)/J
,
U::~7:.,r:s-
I ~;c~o.
~
Tim IS to certify that Ihe request in the abovc apphcatlon and accompanymg documents is m accordance with the City Zoning Ordinance and may pruceed as requested. Tim document
when signed by the CIty Planner constitutes a tempmalY Certificate of ZonIng comphance and allnws eonslruction to commence BcflllT occupancy. a Certificate nf Occupancy must be
J'ssUl'd
Planning Director
Special Conditions, if any
Date
24 honr notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372