HomeMy WebLinkAboutBuilding 05-0284
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
at bottom)
4- 7 z, 7 011t::1/11 (/]) D
Date Rec' d
1- - (5. (Ir;-
White
Pink
Yellow
I PERMIT NO. 05- 02.84-t
File
City
Applicant
(!,IlL
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT I tBLOCK Z..ADDITION
(" "'" () 0 f) 1"--1- I? Ct~:
PID 2-\. z,pg. C 2.-0. 0
OWNER
(Name)
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) /le.
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1::;;'['''''<:,_
// '$:
C, /4, v'/I-.c ,c.:
ORe-Siding OLower Level Fimsh 0 Fireplace
TYPE OF WORK 0 New Construction ODeck OPorch
OAddition OAlteration o Utility Conn
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
III IV V A
HIM R
2 3 4 5
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7<" :2.
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j [. '" ,/ ~ '..,.. (
'--/ i~". ';-- c.' >:;/ 2.
(Phone)
(Phone)
..:"7.'\../
"
B
S U
PROJECT COST /V ALUE $
(excluding land)
x
I hereby certify that I have furnIshed 1.Qfurmation on this application which is to the best of my knowledge true and correct. I also cerl1fy that I am the owner or authonzed agent for the
above. mentIOned properry d t /" nstruct. n will conform to all existIng state and local laws and will proceed in accordance with submllled plans, [am aware that the building
, JUs cause Fuqnermore, ~y agree t!la fficial or a deSIgnee may enter upon the propetty to perform needed mspectlOns '___...
~ .----/-/ /0~.-/' ' 7"" /,>-.- C) <; I
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
Buildlllg Otlicial
Date
Contractor's License No,
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ '1 fe. {/O
I
Paid
Date
Receipt No,
By
ThIS tS to certify that the request in the above applical10n and accompanymg documents is m 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 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