HomeMy WebLinkAboutBuilding 05-0368
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
5 J "J r-
. 0_L~
White
Pink
Yellow
File
City
Applicant
ADDRESS
e..
[PERMIT NO. 05. ''3 &8 J
ZONING (office use)
~tJ.D
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
~,~ ~C>n"-'fhrAC~~
\'
PID '25 /51. OC''1, ()
(Phone) Le 1 ~ -Y4:r -~;;JqCf
(Address)
BmLDE~ ~
(Name) 1.. 1 Q 0 ,,~
(Contact Name) ~~ (' Q~ - de I~,,>+
(Address) \)\ 55 )
(Phone) laS' - ~(Pl/-Yl1- T
~ (Phone)
I h~'hy =tilY ",,' I h,,, furn.h,d infon"h," on thi, ",pl;~l;on whkh i, " <h, h,,, of my knOwi'd", """ 'nd 00""" I '1m rertify <h" I '01 tho """" 01
"<hmi"d ""'"' fo< <h, 'h",~m'"tio",d p"P<"rty "d <h" ,I; oon"",,,,on w;U o""'oon " ,n ~j"ing "," 'nd loc,II'M 'nd will P"ored in "oo,d",,, with
mhmi",d "" I '01 ,w~ <h", <h, building offid,1 ~n ~"k, <hi, p'oni, fOl j~, ~"" F"nh~more, I "'~hy ,_ "", tho oily omd,' 01, d"ign~ m,y
enter upo the property to m needed inspections.
TYPE OF WORK
o New Construction
ODeck
OPorch
ORe-Roofing
o Misc.
OLower Level Finish
o Fireplace OAddition ~Iteration
PROJECTCOST/VALUE (excluding land) $ 3
x
~o 130933
Contractor's License No.
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
'2 5()(~ () U
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
ORe-Siding
OUtility Connection
00
-
3
-oS-
$
$
$
$
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
Building Official
Date
9, ~ ()
Th', , " "",,, ",,' fu, "'"~, " fuo '",",0 'pP'~"", "'d '~O_ying d"ru_. , in =_~ Wi'h fu, Ci~ Zoom, "'.'m~ "'" ~y "'''<oct """'~"d. Th', d=="
wh~ 'igned by th, C;~ p"""",, ,="w,. , "m""., Corti"'" of "min, ~,""Ii."" md illo~ ~"~ctm, "'"'"=nre 'of," "ru""'Y, , C'""~" 'flY""",,, '""" ~
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