HomeMy WebLinkAboutBuilding 02-0927
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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File I PERMIT NO P
2 Pink City .r, ...... - 0 {';)."
3 Yellow Applicant C-/c7< 2'L:.-
ZONING (office use)
05'5' @/~U)d~
9- Sf)
LEGAL DESCRIPTION (office use only)
LOT~LOCK ADDITION ..s -{:-
PID 'd5- ()() -ooS-}
I OWNER
(N ame)
(Address)
(Phone)
BUILDER n
(Name) LA Jhy lu<:t Kr..~/.-;; u..c.
(Contact Name) R.odro~ 0 tdit\~i
(Address) 'i1z.. ~V'<"'~'1 H.;Ll-:. C ~~~ '6~~~
(Phone) 'le:1 'L-LtLt3-tt'i67
(Phone) t, /7 -2to-"5Zh'1
TYPE OF WORK
o New Construction
ODeck
OPorch
~e-ROOfing
o Alteration
DUtility Connection
DLower Level Finish
ORe-Siding
PROJECT COST IV ALUE (excluding land) $
o Fireplace
OAddition
1 hereby certify that 1 have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 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 u e property 0 perform needed inspections.
o Misc.
x
Q
Signature
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
Building Official
Date
lo/5ts, <?D
Contractor's License No.
1/30llJ V
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 $ 16:
Paid
Date
~
-)- ~'- ;
/
I :~eiPtNo!#::;:8
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