HomeMy WebLinkAboutBuilding 03-1580
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CITY OF PRIOR LAKE BUILDING PERMIT, I:, ':': Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIA1jl\: NOV. 1.2. 200..3.. i :;\
AND UTILITY CONNECTION PERMIT I':! : .. :) .
~,~]~e ~:~y I PERMi~ NO. 0.3. /58D I
Yellow Applicant , ,
ZONING (office use)
1</
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID Z5 qz,~. oa.l. {)
OWNER
(Name) \\ol'{ (f('JS5,. Lu TherAY\.
(Address) ('t'\
t. k.u rd..-
(Phone)
BUILDE~ '
(Name) ~ml1- F;fL lrC)~ov-
(Contact Name) '\:J~l\f\.~
(Address)
(Phone)
(Phone)
~-if5/-/~
IPS/- cl5/-t6 17
TYPE OF WORK
o New Construction
DDeck
o Porch
ORe-Roofing
ORe-Siding
OLower Level Finish
o Fireplace
DAddition
~Alteration
OUtility Connection
o Misc.
PROJECT COST IV ALUE (excluding land) $ ~
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or
authorized agent for the above-mentioned 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 building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter po the property to er orm needed inspections.
t-07r
Contractor's License No.
//-5 -0
Date
x
Permit Valuation
lOO~
$ .50
$
$ ISO
$
$
$
$
$
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 $ ;!. -'1. 00
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Paid
Date
Z.tf.oo
/2- . / /. () '3
I Rece~o. 4tRO"f3
By 1- .-
/I-zc:,t) ~
Date ~
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 constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
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