HomeMy WebLinkAboutBuilding 06-1046
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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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Date Rec' d
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I White
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Yellow
File
City
Applicant
I PERMIT NO. (,. /o~6
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDL.-.s-. 33&f. ~z.. 9. 0
OWNER
(Name)
(Address)
(Phone)
~~~~~Name) ~k ,K", ~'''l .T",<-
(Contact Name) -r-e.'-f-".. ~ (.
(Address) / 7'.1 ~- 5'1. /V{"J r... ;;( "v"-.....-
(Phone) 76:/n 7S?-c~~ ()
(Phone)
~~. J :;->'-..?
TYPE OF WORK 0 New Construction ODeck OPorch -Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration o Utility Conn ctlOn
CODE: DI.R.C. DI.B.c. o Mise.
Type of Construction: 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 certily that I have hl1ntshed mtlnmatlOn on this applicatIOn which IS to the best of my knowledge true and correct. I alsu certIfy that I am the uwner ur authurIzed agent lin the
Jbuvc-mentlOned property and that all constructIOn will conform to all eXISting state and local laws and will proceed in accordance with subnlltted plans I am aware that thc buildmg
otEClal 'voke tl1lS permIt I,ll Just ca~' Furthcrmore. I hereby agree that the my officiallll a deSIgnee may enter upon the propeny to perl,"m needed inSpectIons
X, c ,v'.~ j,1(J 3g C ! 03 / /-ckJ .~C~
Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
r Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
lluIidlllg UrIieial
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
TillS IS to certify that Ihe request In the abuve applIcatIOn and aCClJmpanymg documents is In accordance WIth the City Zunmg Ordinance and may pruceed as requested. ThiS document
when signed by the City Planner Cllnslltutes a temporalY CcrtJticate of Zunlng comphancc and allows Cllnstructlon to cummence. Before "ccupaney. a Cntltieate "f Occupancy must be
issLled
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspeetions (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372