HomeMy WebLinkAboutBuilding 05-0523
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
1 White
Pink
Yellow
File
City
Applicant
I PERMIT NO$_ 5J-31
(Please type or print and sign at bottom)
ADDRESS
/5550-
5k'( j/AJU Ifu~
ZONING (office use)
IsO
(Address)
UJ.tu<J
- tJ 3P'
LEGAL DESCRIPTION (office use only)
LOT }q BLOCK ;;;( ADDITION
A-~
(Phon,) 95'..;2- --;~"Y 6"5' 6 yl
fiU/ ,?; ~~ I
OWNER
(Name)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction OOeck OPorch
OAdditlon OAlteration OUtility ConnectlOn
ORe-Siding OLower Leyel Finish 0 Fireplace
CODE: OI.R.C. OI.B.C.
Type of Constmction:
Occupancy Group: A
Division:
o Misc.
PROJECT COST /V ALUE
(excluding land)
...-------
$ ~S-~~
.' IS to the hest of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
--
x
Contractor's License No.
Gas Fireplace Permit Fee
$
$
$
$
$
$
I $
$
[!ark Support Fee
LSAC
Water Meter Size 5/8", I",
#
#
Sewer/Water Connection Fee
#
#
$
$
$
$
$
$
$
$
$
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Pressure Reducer
Water Tower Fee
Sewer & Water Permit Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
[Paid
[Date
lluildlllg Ufficlal
Date
I ThiS IS to certify that the request In the above applIcatIOn and accompanYlOg documents IS In accordance with the City Znning Ordinance and may proceed as requested. ThiS document
I when signed by the CIty PI,umer CllnstItutes a temporalY Certificate of Zomng compliance and allows constructIon tLJ commence. Before occupancy, a Cerllticate of Occupancy must be
I """'"
Planning Director
Date
Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372