HomeMy WebLinkAboutBuilding 06-1042
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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
I White
Pink
Yellow
File
City
Applicant
I PERMIT NO.~ -- j 04 cf-
ZONING (office use)
PI
OWNER
(Name)
h1/J!t-
PI1J'.11~
(Phone)
~;Z- fff ,~ft;?
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
ff//I !/IIZf-(
(Phone) YJ'2.2/2-135/1
TYPE OF WORK 0 New Construction ODeck OPorch :rPiRe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
DAddltlOn OAlteration OUtiJity Conne~n
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV
I
3
V
M
4
o Mise
A
R
5
B
S
U
$
PROJECT COST IV ALUE
(excluding land)
I hereby certify that l have hlrnished mformation on this application which IS to the best of my knowledge tfue and correct. I also certIfy that I am the owner or authOrized agent for the
above-mentIOned property and that all cunstrllctlOn will conform to allexlstmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can rev~c tlm t for Just cause Furthermore, I hereby agree that the City Offi:~~ ~,gnee may enter u on the propel1y to pertorm nJ/~mJ~~!
X -~. ---
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
Gas Fireplace PermIt Fee
This Application Becomes Your Building Permit When Approved
Date
Buildlll~ Orticial
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit I $
Other $
TOTAL DUE $ r;~.----
Paid
Date
.~~o --
1-/~-0
I ~~CC3-:.7d ~-5!J I
This IS to cerufy that the request in the abuve applicatlOn and accompanymg documents is m accordance with the City Zoning Ordinance and may pruceed as requested ThiS document
when signed by the City Plannel constltutcs a temporary Certificate of ZOnIng complIance and allows construction to commence Before nccupancy, a CertifIcate nf Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour lIotice for all illspections (952) 447-985ll. fax (952) 447-,U45
4646 Dakota Street Prior Lake, MN 55372