HomeMy WebLinkAboutBuilding 07-0540
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
/50;i:. rIJ}/ltllwlf/ ~.
n at bottom)
'""
rea T1<I/IL- S.l; ,
Date Rec' d
~?25,07
White
Pink
3 Yellow
File
City
Applicant
I PERMIT NO. 07. 051-0 I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2....5j(PS' os-O,o
OWNER
(N ame)
milt<)( sotf/tN~'I/
) S()7G rJflflU1ll.lAJ :3f/Ollt::'"'$.
17<lIll... -9," L;
(Phone) j$2" Cf4l-..$JI~b
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing j8Re-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
V
M
4
A
R
5
I
E
II
F
I
III
H
2
IV
I
3
o Mise.
B
S
U
PROJECT COST IV ALUE
(excluding land)
#
$ 2,t::)oo,~
I hereby certlty that I have hlrmshed 101,)rmatJon on thiS application which is to the best of my knowledge true and correct I also certify that I am the owner <lI authollzed agent IDr the
abovc-mentIOllcd property and that all cunstrllctIOn will conform to allcxlstlllg state and local laws and will proceed in accordancc with submItted plans I am aware that the buildlllg
official can revokc thlS rmlt for Just calise Furthermore, I hereby agree that the CIty official or a deSIgnee may enter upon the prOpclty to perform needed Inspections
x
Signature
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permtt Fee $
This Application Becomes Your Building Permit When Approved
lluildlllg Orticlal
l)ak
Contractor's License No.
Park Support Fee
SAC
#
#
(p, zr.c-'7
Date
$
$
$
$
$
$
$
.cJV
ThlS IS to certify that the requl'st 1Il the above application and accompanYll1g documents is 1I1 accordance WIth the City Zoning Ordinance and may procced as requcsted ThIS document
when SIgned by the City Planner constItutes a temporary Cerl1licate of Zonll1g compliance and allows constructton to commence Bcfme occupaocy. a Certificate of Occupancy must be
isslled
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Planning Director
Date
24 hour notice for all inspections (952) .U7-91l50. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions. if any