HomeMy WebLinkAboutBuilding 07-0992
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE. .
AND UTILITY CONNECTION PERMIT
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LEGAL DESCRIPTION (office use only)
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Date Rec' d
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2. Pink City
J Yellow Applico..
I PERMIT NO. 0 7 - C{ 't -z.. I
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(Address) l11 ~ s \1: ci'1 wo c J
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U. sf
BUILDER
(Company Name)
(Contact Name) 111 (..
(Address)5&'I/ /J;emor/a/ A. /1.
(phone) q ~ 2 - 2. 'Z G, - 110 8
(phone) !/GI d/ :J; 9. "/. 3 ;)..()
(phone)
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TYPE OF WORK DNew Construction DDedc OPorch .Rooting ORe.Siding OLower Level Finish
DAddition OAlteration OUtility Connection 0 Misc.
. CODE: ~.R.C. OI.B.C.
Typeof~on: I n m IV V A B
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 4 5
o Fireplace
PR.OJECT COST IV ALUE S
(exc1udiDgland)
5" J '33 ~ -
I ba'eby certifY that I have furnished information on this application which is to the best of my lcnowledge aue and COlTtCt. I also certifY that I am the own~"I' OJ' authorized agent for the
above-lI1tI\boned proptI'ly and that all consauction will conform to all existina stale and local laws and will )lI'OCtCd in accordance with submiued plans. I am aware that the buildinl
official can revoIce this pmnit for just cause. Furthct'lllOt't, I hereby aJI'CC that the city ofllcia1 or a dcsiJnee may enter upon the)ll'Operty to perform needed inspections.
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SignatuJe Contractor's License No. Dare
Permit Valuation 2~.-
Permit Fee S 1~.1<;
Plan Check Fee S
State Surcharge S \ ~ 'Z-.c;-
Penalty S
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee S
Gas Fireplace Permit Fee $
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01
Park Support Fee # $
SAC # S
Water Meter Size S/8"; 1 "; S
Pressure Reducer $
Sewer/Water Connection Fee # S
Water Tower Fee # S
Builder's Deposit S
Other S
TOTAL DUE $ [<0 _ -
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(0 ~'"51 07
,
I Paid
Date
I :;ceiPt NO~tl5J
nlls is to certifY thaI the request in the above application and accompanyinl docull1tl\llI is in accordance with the City Zoninl OrdinanCt and may proctcd as requested. This document
when sisned by the City Planner constitutes a temporary Cerlilicate of Zoninl complianct and allows consauClion to commence. Before occ:upancy, a C~"I'tiflCltc of Occupancy must be
issued
Planning Dircctoi
Dale Special Coaditions, if my
24 hour notice for allln.pedion. (~2) 447.98~. fax (m) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 55372