HomeMy WebLinkAboutBuilding 05-0841
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
8. so. oS
at bottom)
ADDRESS
4924- ;"1/#/1/6fOm Jr.
LEGAL DESCRIPTION (office use only)
\ White
2. Pink
Yellow
File
City
Applicant
\ PERMIT NO. oS.084-/ \
ZONING (office use)
~z-
PID Zs. 0 (;J . (JO&. ()
LOT
BLOCK
ADDITION
OWNER
(N ame)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) ), b'?C
TYPE OF WORK 0 New Construction ODeck
OAddition o Alteration
CODE: oI.R.C. oI.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
(Phone)
(Phone)
(Phone)
OLower Level Finish 0 Fireplace
B
S U
PROJECT COST IV ALUE $
(excluding land)
x
n this application which is to the best of my knowledge true and correct. I also certlfy that I am the owner or authonzed agent for the
n will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
hermore, I hereby agree that the CIty offIcial or a de. signee may en.n~t on the properry to perform needed mspectlon. s.
C-~/ ~ ~
q~,~ ,,' .-::3J-eJ")
Contractor's License No. Date
I hl'!eby certify that 1 have furnished mformatio
above-mentlOned properry and that all co u-tl
official ~ke this perm' r JIl F
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
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ '7?OtJ
,
BUlldll1!! Official
ThIS IS to certify that the request m the above appl1catlon and accompanymg documents IS Il1 accordance with the City ZOlllng Ordinance and may proceed as requested ThiS document
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\ issued
Date
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