HomeMy WebLinkAboutBuilding 01-0360
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
I. White File
2. Pink City
3. Yellow Applicant
ZONING (office use)
Nb
s- S 3 7 ~
rz-
LEGAL DESCRIPTION (office use only) . I L /' . I I
II J )IN'; A 5 n"f"t" t'1l,.. S -- ..YCe)I"f d ~~,' ,'""
LOT BLOCK ADDITION
PID 2SwO~8<'/1-C)
OWNER
(Name)
/l//~h ~ I-eK
521 s- tIa hi ~ lor- s l
IJE
jJ, '0 r
(Phone)
q~ c -4q ~-- 3'7~b
..5"..S- 3 7 2..
(Address)
L 4 k r,
1111'1
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
~eck
o Fireplace
o Porch
ORe-Roofing
ORe-Siding
OLower Level Finish
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 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
:nter upo~#rm needed inspections.
Signature Contractor's License No. Date
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
'Lceo. -
$ ~1.2 5
$ t 5 .O(
$ .CO
$
$
$
$
$
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1 "; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 1l~.Z~
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
pproved
Paid
Date
~ 'l-~
'Z. '1P (
I Recei~O. 3~sz=?.3
By l<I-
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
PRIOR LAKE
INSPECTION
RECORD
52. 'l S- H~,.N s;..
Dec..t<- ~
~ A~
DATE ISSUED
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
TYPE OF WORK
USE OF BUILDING
PERMIT NO. 01- SbO
BUILDER AU-t:=N VA~€-,,-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
) ~
4/z~/ol
Ii
INSPECTOR
5" ~ &,
E HAS BEEN SIGNED
I
I
DATE
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-9850
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