HomeMy WebLinkAboutBuilding 07-0928
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
<1 Z8. ()l
n at bottom)
(Please
ADDRESS
5201
I White
Pink
Yellow
I PERMIT NO. 07. (j 9z'b I
File
City
Applicant
ZONING (office lIse)
LEGAL DESCRIPTION (office use only)
LOT '~OCK ADDITION
PID
OWNER
(Name)
(Address)
(Phone) (95Z )Z2LJ - U UB
(Phone) lCl5Z)g I') -l22-1
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch o Re.Roofing
OAddition OAlteration o Utility ConnectIOn
OLower Level Finish 0 Fireplace
CODE: DI.R.C. DI.B.C. o Mise
Type of Construction: I II III IV V A B PROJECT COST IV ALUE $ 21)} CXJO
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby cCflity that I have furnished mformation on this applicJtlon which is to the best of my knowledge true and correct. I also certify that I am the owner or fluthonzed agent for the
abllvc-mentHlned property and that all constrUc!lon will conhJrm to all eXlstmg state and local laws and will proceed in accordance with submIlted plans I am aware that the bmldmg
~tiC1\\,\[~ryr2JllSt ~IUY\[L~Y agree that the Cl~ official or a(D~t5Y enter upon the propeny to pert(nm ncrj7~701__
Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Huildll1~ Ufficlal
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 $
ThiS IS to certify that the request in the above application and accompanYll1g documents is 111 accordance WIth the City Zoning Ordinancc and may procccd as requcstcd ThiS document
\\'hen signed by the CIty Planner constltutes a temporary Certificate of Zon1l1g compliance and allows construction to commence Bcfllre occupancy, a Certificate of Occupancy must be
isslled
Planning Director
Special Conditions, if any
Date
24 hour notiee for all inspections (952) 447-9R50, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372