HomeMy WebLinkAboutBuilding 07-0896
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE. .
AND UTILITY CONNECTION PERMIT
(...... .... M ....' ad dID .. ......~
I ADDRESS
. () 5 t./{p 5' rl ~~((Q .~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
Date Rec' d
I. While File
2. Pink Cily
) Yellow Applicln!
Q.19.0!
I PERMIT NO. 07.0 e>Cjft? I
I
I WNlNGC__l I
I OWNER
(Name)
(Address)
\ \r- \ ~ ll--e
'\)6- IfY\
BUll-DER '
(Company Name) t.u \(e.w)cy-..&.~ '"":R~~-eShf\~
(Contact Name) ~~...:.,.~. ~li-'lZ - S~
(Address) -0. -) .
TYPE OF WORK 0 New Construction ODed
OAddition OAlteration
CODE: OJ.R.C. OJ.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
n
F
1
m IV V
H J M
234
A B
R S U
5
(i'hone)
r;:::) ~~:J~;e "'-~~e;.,
IJ\ ~ 5S <f;tD
OLower Level Finish 0 Fireplace
PROJECT COST IV ALUE $
(excluding land)
[ hl'l"eby certifY that [ have furnished information on this application which is 10 the best of my knowledge lnIe and correct. I also certify that I am the owner or authorized agent for the
above-mentioned pmperty and that aU construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
OffiCi?;!.! pern,,1 for just cause. Furthermore, I here~r agree that the city official or a de~ignee may enter upon the pmperty to perform needed IIlSpcctions.
^ ......~ ~~ a04-43D~~ q-IO-t)7
Signature Contractor's License No. Dare
Permit Valuation
Permit Fee $
Plan Check Fee S
State Surcharge $
Penalty S
Plumbing Permit Fee $
Mechanical Permit Fee S
Sewer & Water Permit Fee S
Gas Fireplace Permit Fee $
This Application Becomes Your Buildins Pennit When Approved
Buildinll Official
Dale
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1 "; S
Pressure Reducer $
Sewer/Water Connection Fee # S
Water Tower Fee # S
Builder's Deposit $
Other $
TOTAL DUE ^ S70~
I J
I Paid 7(d - IRec bi6t No. 5~5+- I
I Date ., ,/ '1-- 01 I Bv -
()
. ThIS is to certifY that thc request in the above application and accompanying documents is in accordance with the City Zonina Ordinance and may proceed as requcsted. This document
when sillnl'll by the City Planner constitutcs a temporary Certificate of Zoning compliance and allows conslnlction to commence. Before occupancy, a Cl'l1ifacate of Occupancy must be
issued
P1annina Director
Date Soecial Conditiona, if any
24 hour notice for IlIlnspectlonl (9!12) 447.98!1O, fiX (9!ll) 447-424!1
16200 Eagle Creek Avenue Prior Lake, MN 55372