HomeMy WebLinkAboutBuilding 05-0198
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
/ <f- 7 -1-&
~rt7~t:~
Date Rec' d
3 l z. c:)
~i~i~e ~:~y I PERMIT NO. O~J _ () /1' r'/
Yellow Applicant , ,
L.,J.
ICI
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25. 2- !-Yl-. 0 Z(" ()
OWNER
(Name)
/I {./ L7JtlW .J I /",1/ tYtrrrb.. L
/
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
/C4;:.-e;V JElL
'f-f2_ ?J/?'L
/Ct.' ~~/N6;
/
(Phone)
(Phone)
:Jl) /VOrn~
TYPE OF WORK 0 New Construction ODeck o Porch e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
DAddition o Alteration DUtility Conn tion 0 Mise.
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
B
S U
PROJECT COST /V ALUE $
(excluding land)
I hereby certify that I have hlrnished mformation on this application which is to the best Df my knowledge true and correct. I also certify that I am the owner or authOrIzed agent for the
abDve-mentlOned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans I am aware that the buildmg
olficial can revoke thl~.permit for Just cause Furthermorc, I hereby agree that the CIty olficial or a desIgnee may enter upon the property to perform needed mspectiOns.
~UZ ~aa/L dClcJ3/7S' 3--;J;)-OS
Signature
x
Date
Permit Valuation 2/ Jtru, ,I))
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Pennit When Approved
Buildlll!! Ollicial
Date
Contractor's License No.
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 $ 7&.00
Paid
Date
"fiR. ,"U
J. l. L () s.-
I ~~ce~~t.
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 consl1lutes 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