HomeMy WebLinkAboutBuilding 03-1189
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
q,4rOJ
White File I PERMIT NO
Pink City . I'\? _ ///'1. q
3 Yellow Applicant Vd... __~
ZONING (office use)
LEGAL DESCRlPTION (office use only)
LOT
BLOCK
ADDITION
(Phone) biz - 2575 -~Z.I
OWNER
(Name)
..J~~ u.J/~
~Ah\G
(Address)
PID 25 -It::c/ - oi3 -- 0
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
Re-Siding
o Misc.
PROJECT COST IV ALUE (excluding land) $
ODeck
OPorch
e-Roofing
o Fireplace
OAddition
o Alteration
DUtility 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 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 upon the property to perform needed inspections.
x
Signature
Contractor's License No.
Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
,2-S
Sewer & Water Permit Fee
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 ,UfiAiWJ q ,~,D] $ 7fLJ, -
ve application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
s a temporary Certificate of Zonmg compliance and allows constructIOn to commence Before occupancy, a Certificate of Occupancy must be
'1 Is L~-"
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