HomeMy WebLinkAboutBuilding 05-0926
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
,1
~ ,."..f r
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] White
Pink
YeJlo\l.'
File
City
Applicant
i PERMIT NO. 0 :) ~1Z0
"j
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ZONING (office use)
it, Il)
-2-
LEGAL DESCRlPTlON (office use only)
LOT
BLOCK
ADDITION
PID 2~-001_/1{,_tp
OWNER
(Name)
<S'cIJ '1 ~l~{--e V
(Address)
f)'
~ht"/~
IYq"L<?
(Phone)
9)"2- - Y<-j()- ~4tj
'-'
i BUILDER
I (Company Name)
I
I (Contact Name)
(Address)
5 c( vv\. J:?_
(Phone)
(Phone)
o New Construction ODeck OPorch Re.Roofing ORe-Siding OLower Level Finrsh 0 Fireplace
OAddition OAlteration o Utility Connecti
CODE: I.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV V
HIM
234
PROJECT COST IV ALUE
(excluding land)
I hereby certity that J have hlrnlshed rnltJrmatlOn on this applicatIOn which IS to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent It)! the
Jbovc-mentwned property and that all constructlc~Jnform to all eXlstrng state and local laws and will proceed in accordance with submItted plans J am aware that the buildrng
'Jllina! can revoke tillS permll for Just cause Fur ermore, I hereby agree that the CIty official or a deSIgnee may enter upon the properry to perlorm needcd rnspectHlI1S
' q- Z/-c} I:J'"
x
Permit Valuation
Permit Fee
$
$
$
$
$
$
$
$
1.2
Plan Check Fee
Stale Surcharge
I Penalty
I Plumbing Permit Fee
/Mechanical Permit Fee
fSewer & Water Permit Fee
~ Gas Fireplace P rmIt Fee
o Misc.
A
R
5
B
S
U
$
Contractor's License No.
Date
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 $ '70. -
I Paid
Date
1!~7 ;<(
f
i ReceiEt N~
I By
~
rTlllS " to certify that the request rn the above applicatIOn and accompanyrng documents IS in accordance with the City Zoning Ordinance and may proceed as requested TIllS document
when signed by the City Planner CllnslItutes a remporJlY Certificate of Zonmg compliance and allows construction to commence. Before occupancy, a Certllicate of Occupancy mUst be
I !ssued
L
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