HomeMy WebLinkAboutBuilding 02-0560
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3 . Yellow Applicant
Date Rec' d
5,-~'DY
I PERMIT NO(}J-J 0(j
SE
ZON (office use)
f? 1/
LEGAL DESCRIPTION (office use only)
LOTd-BLOCK 3ADDITION p~~
IL/d
PID
9- 610-
OvrNER .
(Name) .5 ~^-r \
t3t: r \ o...d..~
(Phone) LJ'J 0-8s s-I
(Address)
BUILDER 1\11 .;:L \ '\ \
(Name)-tliJc.v', rtOU'"'C
(Contact Name) ~l~
(Phone) (& 12) 49P ~~)>t~.5-
(Phone)
(Address)
(.>.
.) fA}.. //11
TYPE OF WORK
o New Construction
DDeck
DPorch
ORe-Roofing
e-Siding
o Lower Level Finish
o Fireplace
OAddition
OAlteration
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 a that an construction will conform to an existing state and local laws and will proceed in accordance with
e building 0 1 can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
. ectio s.
Contractor's License No.
~-I;l(J 102-
, Dite
X
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $ I,
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
1/-/72- 25/S-
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 $ 7L ,UJ
Paid
Date
~ 7{p. ~
~;,;j -.J-
I Receipt No.: Lf d 6 (7 ~
By Cr=""
(
"
This Application Becomes Your Building Permit When Approved
Building Official
Date
This is 10 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