HomeMy WebLinkAboutBuilding 06-1058
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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
,~ Lj5 (j
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
White
Pink
Yellow
File
City
Applicant
[ PERMIT NO.
o~-/os~
ZONING (office use)
. Ii ell f)/L~
PID
/ {)//l
(Address)
S'AAAtJ II
31ft;fJ-
r;tJrJ -, If; ~ tJl'-/
/3E. ull 17<1..
BUILDER
(Company Name)
(Contact Name)
(Address)
TYPE OF WORK 0 New Construction ODeck OPorch Re-Roofing ORe-Siding OLower Level Fimsh 0 Fireplace
OAdditlon o Alteration OUtility Conne tlO
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV V
HIM
234
o Mise.
A
R
5
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby certify that 1 have hlrnishcd mformation on this applicatIon which is to the best of my knowledge true and correct. I alsll certify that I am the owner or <luthnnzed agent for the
JbovC-mcntlOned property and that ,ill cunstruction will conform to all eXIstmg state and lucallaws and will proceed in accordance with submitted. plans_ I am ilware that the buildmg
Ilfflcial can revllke tillS permIt 'Ilr Jl/Sl' Furthermore, I hereby agre' ~e CIty offIcial or a deSIgnee may enter upon the propclty to perlilrm needed mspecllllns
X ''/1/~ ~," ?~ /I~ ~'C, _::(03 ~o31t6 //A~6
Signature Contractor's License No, Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Pennit When Approved
lluildl1lg Oftlcial
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 $ 'i r;.
Paid
Date
~ rr, .--
/- (3-()-- '-'
~/
I ~~c&:5;)5S1s
ThlS IS to certify that the request in the above applicatlun and accompanYlllg documents is 111 accordance with the City Zoning Ordinance and may proceed as requested Thls dllCument
when signed by the CIty Planner CllnslIllltes a temporary Certificate of Zonmg compliance and allows constructIOn to commence. Before occupancy, a Cl'lllficate Ill' Occupancy mllst be
'."sued
Planning Director
Special Conditions, if any
Dale
H hnur I\nticr for all il\Spl'ctinl\s (9S2) ~~7-98S0. fax (9S2) ~47-~2~S
4646 Dakota Street Prior Lake, MN 55372