HomeMy WebLinkAboutBuilding 05-0939
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
at bottom)
'5~~
LEGAL DESCRIPTION (office use only)
LOTi BLOCK ! ADDITION W ~d
Date Rec' d
White
Pink
Yellow
File
City
Applicant
I PERMITNO.tJ{i'-?~11
rY /'-v ~
ZONING (office use)
Es/ /51-
PID ~ 80-
OWNER
(N ame)
/11/ 11e // /Y
(Phone)
tog
,
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(VC) k ftJ 4edcu.-/
J
?crP-
-"?/" -" ~, - 'j
/#' ..J - 5 'I / - b ) (0'
,
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TYPE OF WORK 0 New Construction ODeck OPorch r1'Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAdditlOn OAlteration OUtility ConnecQn
CODE: DI.R.C. DI.B.c.
Type of Construction:
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
U
PROJECT COST /V ALUE $
(excluding land)
I hereby certify that I have tmmshed 1Oformatwn 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
abllve-mcntwned property and that all c nstruction wIll conform to all istmg slate and local laws and wIll proceed m accordance with submItted plans [am aware that the buildmg
"f1iClal ca~. """ Cm '0" '" '''"'"m. '''''' , , "" ", '" om,,,, ''',' ',,,""eo =, '00" "eo" ffi, m"'"'' m "",,~ """';;:~"'~ /,
x ~ r/" .?/ Xc:;.. ..,('1L"/.5' /s -< ~ 6' "' ..-;.,..> ,/,:-:9 >
" r- Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fec $
State Surcharge $
Penalty $
, Plumbing Permit Fee $
r Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Buildlllu Utllclal
Date
ThiS IS to certIfy that the request In the above applicatIOn and accompanY1Og documents is 10 accordance with the City Zoning Ordinance and may proceed as requested. TIllS document
when ....igned by the City Planner constItutes a tempOf31Y Certificate of Zoning compliance dnd allows construction to commence Before occupancy, a Certlficate of Occupancy must be
I isslled
I
I
c__
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ -/L,~-
- ~tf'
0~ -- I ReceiptNo.~ I
- "f-~ By cg--_ .
Paid
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