HomeMy WebLinkAboutBuilding 07-0676
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
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0/1 ,tA:.'//7'7
.5,-/l2-C~/
Date Rec' d
2- 1. 07
I
I While
Pink
Yellow
File
City
Applicant
PERMIT NO.OJ: dc':'l~.,
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
I ~f llC'~ /~;E--J[ / ( o.cJ ..' C-oe-CL-
'"
L-c /; ~'IcL
(Phone)
c;J~' .- c( c;& '~l / (J tJ
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
I'? 0
JrCv{'...Q..- .J ~
2s>'A- t-- J?- S;:' at
! 1 C/OSL 3'-1.1.'
(Phone)
(Phone)
?j;;.. :A 7';;,.": ,-();;' 7
r/
TYPE OF WORK 0 New Construction ODeck OPorch e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAdditIOn OAlteration o Utility Con nee IOn
CODE: DI.R.C. DI.B.C. o Misc.
Type of Constmction: I II III IV V A B PROJECT COST /V ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
I hereby certify that I have turmshed 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
,lbovc-mentlLlned property and that all constructlLln will conf()rm to all eXisting state and local laws and will proceed in accordance with submltted plans. I am aware that the building
offiCial can revoke tlus pCl'l\7It for Just cal e 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 $
I Penalty $
I Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Iluildlllg Urtlclal
Date
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
Tim IS to certify that the request In the above applicatIon and accompanymg documents IS In accordance with the City loning Ordinance and may pruceed as requested. ThiS document
when signed hy the City Planner comtIttltes a temporary Certificate uf Zonmg compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
isslled
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372