HomeMy WebLinkAboutBuilding 05-0869
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
5/1
A
LEGAL DESCRIPTION (office use only)
LOT~ BLOCK 3ADDITION a ~
tf;: Jt~
S(/ NB,
~ .~
! 0 m Cf-ej.R/k./ . .
OWNER
(Name)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
Date Rec' d
I While
Pink
3 Yellow
I PERMIT NOt'S- - 8611
File
City
Applicant
ZONING (office use)
PID
d- CJ3,
(Phone)~ YY7 66:c5
(Phone) ~/d- 3~'J-L/JJJ
(Phone)
TYPE OF WORK 0 New Construction DDeck DPorch
DAddition DAlteration o Utility Conne I
CODE: DI.R.C. DI.B.C.
Type of Constnlction:
Occupancy Group: A B
Division:
I
E
II
F
1
III IV V A
HIM R
2 3 4 5
e-Siding DLower Level Finish 0 Fireplace
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby certify that I have tltrnished mformation on this application which is to the best llf my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentlOned property and that all construction will conform to all existing Slate and local laws and will proceed in accordance with submItted plans. [am aware that the buildmg
~fiClal can revoke thiS pelm!t for ust cause FlIlthclmOle. I hereby agree that the City offiCial or a des~~ 5?-7~ p~m needed mspectl9'(~ b j
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 I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Bui[dl11~ Ufticial
Dale
Park Support Fee # $
SAC # $
Waler Meter Size 5/8"; I", $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ -JI/? --
~l!;_;~_
I ~~'e~n saJo-5-
~
Paid
Date
ThiS IS to certifY that the request in the above applIcatIon and accompanymg documents is Il1 accordance WIth the City Zoning Ordinance and may proceed as requesled. TIllS document
when signed by the City Planner constitutes a temporary Certificate of Zonmg compliance and allows constructIon to commence. Before occupancy, a Certificate of Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspeetious (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372