HomeMy WebLinkAboutBuilding 05-0298
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
g.,q J.f hI' {} cJ LJ
3 (p(p 9
Date Rec' d
f. 20. 05
White
Pink
Yellow
File
City
Applicant
I PERMIT NO. 05. {;Z 98
~II'- S(.,U
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
PID Z~-: 2- +e. 039 0
BLOCK
OWNER
(N ame)
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
KY'~~-eL
1"1\,
~Co SOW
(2-w O~0 ~L
00 -\--t-- S"t ~
(Phone)
(Phone)
\:) rd.. c..... ~
q ~~ -L(q ~ - 3~Lf d-
TYPE OF WORK 0 New Construction ODeck o Porch e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration OUtility Conn cUon 0 Misc.
CODE: DI.R.C. DI.B.C.
Type of Constmction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST /V ALUE $
(excluding land)
I hereby certify that I have furnished mformatlOn on this application which is to the best of my knowledge true and correct. I also certIfy that I am the owner or authollzed agent for the
above-menlloned property and that all construction will conform to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
:rlcial~ok t permll for Just cause Furthermore, I hereby agree that the CIty official or a designee may enter upon the property to perform needed ~la'ol 0 r
Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Pennit When Approved
Buildl11l! Otllcial
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 7 f/. c/c/
Paid
Date
-J(/ . s:
tf. U _1/
I ~;"~
-
,r:f-1'tz/ I
ThiS IS to certify that the request m the above applicallon and accompanymg 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 Zonmg compliance and allows construcllon 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