HomeMy WebLinkAboutBuilding 03-0767
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
& /2.0J
I White File I PERMIT NO I
2 Pink City . /) ;:> - 07'--"1
3. Yellow Applicant , tI-=:> (0 I
1?3B
/iffl~01 &Ef:.'/ f)UII&
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
OWNER
(Name)
lvtrE-
8'/s
(Address)
PID . - ~ 4-tJ Z. . (.)5"4-. 0
(Phone)
'5/-~5"z.- Sa?C>
BUILDER
(Name)
(Contact Name)
(Address)
SAffl ~
f4ar- 7~~
(Phone)
(Phone) t/Z-Z-Z/ - ~
TYPE OF WORK
o New Construction
ORe-Roofing
o Lower Level Finish
o Misc.
,'I
PROJECT COST IV ALUE (excluding land) $
DDeck
DPorch
DAddition
ORe-Siding
o Fireplace
OAlteration
OUtility Connection
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 aw. e that the~' ,-ng official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the property t ,perfo m d ij1spections.
, '
x
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Contractor's License No. Date
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 $
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.
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
Planning Director