HomeMy WebLinkAboutBuilding 05-0290
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
- eo..f .......... (JD
Date Rec' d
+. /8.o~
White
Pink
Yellow
File
City
Applicant
I PERMIT NO. Of). 0210
I
ZONING (office use)
LEGAL DESCRlPTION (office use only)
LOT
BLOCK
ADDITION
PID~ ~6o. 018.0
OWNER
(Name)
0?rV
'7'~ -- ~
5'/~t!~
(
(Address)
(Phone) bid -.).0/_ //5'//
BUILDER
(Company Name)
(Contact Name)
~~I
~,-I
/
~()- ?6 7,. 6 f1'.27
;;:.-. -(" .
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Root r:'" t7
/'
TYPE OF WORK 0 New Construction oDeck oPorch ~Re-Roofing ORe-Siding oLower Level Finish 0 Fireplace
oAddition oAlteration oUtility Connection 0 Misc.
I hereby certifY that I have hlrmshed mformation on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or authof1zed agent for the
above-mentlOned property and that all construction will conform to all eXlstmg state and local laws and will proceed in accordance with submItted plans. I am aware that the buildmg
official can revoke thIS permIt for Just cause Furtherm ereby agree that the CIty official or a deSIgnee may enter upon the property to perform needed mspectlons
JtJ/7rcpS"" i'-/~-- O.~
Contractor's License No. Date
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV V A
HIM R
2 3 4 5
x
Signature
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 Permit When Approved
Buildll1!! Ot1icial
Date
B
S U
PROJECT COST IV ALUE $
(excluding land)
c; OClO
$
$
$
$
$
$
$
$
$
Park Support Fee
SAC
#
#
Paid
Date
~y;~
1:;ceiPt~~ I
Planning Director
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
ThiS IS to certIfy that the request m the above application and accompanymg documents is in accordance with the City Zonmg Ordinance and may proceed as requested. ThIS document
when signed by the City Planner constitutes a temporary Certificate of Zonmg compliance and allows construction to commence Before occupancy, a CertIficate of Occupancy must be
issued
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any