HomeMy WebLinkAboutBuilding 05-0512
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
C.Z-,o~
I White
Pink
Yellow
File
City
Applicant
PERMIT NO. 05", oS/2...
(Please
ADDRESS
ZONING (office lIse)
S'IO
;:;"1 If t..A~N
~ott~~
LEGAL DESCRIPTION (ofllce use only)
LOT
BLOCK
ADDITION
PID ,?G".031. () I O. I
OWNER
(Name)
(Phone)
'f~ SIr? JI..<;/I'S-
(Address)
(Address)
7f'ER(J(JF Amt;.!?/ eA
D/kI/S. ~ leI c./(".r_,-y
I () ?~a .t f"/V lJA-L~ Av;:
~I
(Phone)
(Phone)
/3 L.. aa/YJI'''-'(i TtI;v
?S,l
P't,.. I'Yf/ d
BUILDER
(Company Name)
(Contact Name)
0:;
m;V ~S-~~ 0
TYPE OF WORK 0 New Construction ODeck OPorch
OAddition OAlteration OUtility Con
e-Roofing
cHon
ORe-Siding
OLower Level Fimsh
o Fireplace
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
o Misc.
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
B
S U
PROJECT COST /V ALUE
(excluding land)
$
x
L , plication which 15 to the hest of my knowledge true and correct. 1 also certify that I am the owner or allthonzed agent for the
, rllction will nform to all existmg state and local laws and will proceed in accordance with submitted plans_ I am aware that the buildmg
7::ee that the C1~ Offi;' ; a::::c~m;;;~r ;on the propelty to pcrt\1fm n;e~ l~ec~Ol~ s-
Contractor's License No Date
Sewer & Water Permit Fee
Gas Fireplace Permll Fee
$
$
I $
$
Water Tower Fee
#
#
$
$
$
$
$
$
$
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
$
$
$
Park Support Fee
SAC
#
#
Permit Valuation
Permit Fee
Water Meter Size 5/8", 1";
Pressure Reducer
$
Sewer/Water Connection Fee
Builder's Deposit
Other
This Application Becomes Your Building Permit When Approved
[Paid
Date
~(..,(-' U
cP. Z J.;.-
TOTAL DUE
1l11lIdJl1l! Umclal
Date
J
ThIS IS to certify that the request m the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted TillS document
when signed by the City Planner CU!1st!tutcs a tcmporary Certificate uf Zomng compliance and alluws construction to commence Before occupancy, a Certificate of Occupancy must be
issued
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