HomeMy WebLinkAboutBuilding 05-0304
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3 Yellow
File
City
Applicant
PERMIT NO.
Car I'
Prior La
LEGAL DESCRIPTION (office use only)
LOT . BLOCK.:L ADDITION
OWNER (YJ" . A
(Name) /chae1 ~ nn
(Address) /47'-/6 6r(l'd
I-
PID
Date Rec' d
(Phone) (752- -'-/'-17 ~5).4 3
ml\J 5531
ODeck
OPorch
ORe-Roofing
BUILDER S' de'
(N ame) and u... em 5 h--uLh On
(Contact Name) J(eU/'" SJy)dau.....
(Address) 30/0 usf 4'1!:
CD.) Ine-
(Phone)
(Phone)
venue,
ShJko
ee,
TYPE OF WORK
o New Construction
o Fireplace
OAddition
o Alteration
OLower Level Finish
b;.Re-Siding
OUtility Connection
o Misc.
I hereby certify that I have furnished information 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 above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. I am aW,are ~~~ild, ing official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
X '" pon (he pmperty ~l?e<f( ..::;;j: ~ _6 C - 1)5/ {)II -15-05
Signature Contractor's License No. Date
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
PROJECT COST IV ALUE (excluding land) $
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
#
#
Builder's Deposit
Other
TOTAL DUE
\ Paid
Date
1;; --
11 : ~
, -~).O - !.)
=[ Receipt No,
By d
This Application Becomes Your Building Permit When Approved
Building Official
Date
$
$
$
$
$
$
$
$
$
??&- .-
V>5j( ~'
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
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