HomeMy WebLinkAboutBuilding 03-1110
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
g.2loJ
(Please type or print and sign at bottom)
ADDRESS
3lf S, t.\.L l 'Ct.\.) ~h
1. While File I PERMIT NO
2. Pink City . /?3 - I / /0
3. Yellow Applicant , (./_
,,:tA'\ \ - ~~\O (L L,.:\:t-€-,
yY\ \\.1
ZONING (office use)
e. /.s..o
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
k~f2W ':\) ~
345.., Uh Hew ~e
(Address)
(Contact Name)
(Address)
PID 2.5 /0'1, 0(1(,. 0
(Phone)
T(l.A \ \ ... P (Z.\CIZ ~l~
QS"2-44.'7- &5'2-5
liV )"5J) z..
{'LSS
Sr:~l LJ (c~.>
(Phone)
(Phone)
~L-':l'-n -161 'is
t: 1 -Ll'--Cl -- (0, ~
TYPE OF WORK
o New Construction
ORe-Siding
OLower Level Finish
o Misc.
ODeck
OPorch
ORe-Roofing
~lteration
o Fireplace
OAddition
OUtility Connection
PROJECT COST/VALUE (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
or the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
am aware that he building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
erty to per needed insp~s. . . c:: ./ I
' .-..~-Vt"'~_ '"'l..(i~~"2-~ / ~Il '1 0'")
Signature Contractor's License No. Date
x
Permit Valuation Z, 5' () 0 (JO
Permit Fee $ 7<-( 7s-
Plan Check Fee $ '-
State Surcharge $ 1.25
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Pennit When Approved
r) "
IY-f..1 t-(.("
1~p
J1z ciu3
Date
Building Official
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 $
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 Spccial Conditions, if any
24 hour notice for all insDections (952) 447-9850. fax (952) 447-4245
Planning Dircctor