HomeMy WebLinkAboutBuilding 06-0917
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
White
Pink
Yellow
File
City
Applicant
\ PERMIT NO. 06, - 9/ 'Ii
(Please
ADDRESS
ZONING (office use)
I~~~f()
S't~ ?~G/
,fveJ
LEGAL DESCRIPTION (o!f1ce use only)
LOT
BLOCK
ADDITION
y
I
PID
OWNER J
(Name) , ~ -,~
~ //vJrCJJ/1-
, LJ {./ ,\ (/ ./
(Phone) q 5 ~.-/77J(J''''' a I (j ~
(Address)
COl1j~ 7<
.,-
(Phone) 6/t,~c, )()~6Y;~
(Phone) ~ ,- -"J,:/LJ..- 1".) .p
/-~
TYPE OF WORK 0 New Construction ODeck
OAddition OAlteration
ORe-Siding OLower Level Finish 0 Fireplace
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
o Misc,
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
B
S U
PROJECT COST IV ALUE
(excluding land)
$
I hereby certlty that 1 have furmshed mformation on this application which is to the best of my knowledge true and correct I also certify that I am the owner or authonzed agent for the
above-mentIOned property and that aY"rstruction will conform to all eXlstmg state and local laws and will proceed in accordance with submltted plans I am aware that the buildmg
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Signature Contractor's License No Date
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
Park Support Fee
SAC
#
#
Sewer & Water Permit Fee
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
#
#
$
$
$
$
$
$
$
$
$
Permit Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Water Meter Size 5/8"; 1";
Pressure Reducer
Plan Check Fee
TOTAL DUE
This Application Becomes Your Building Pennit When Approved
Paid
Date
~'~;b
I ~;ceiPt N~~S
Buildll1g Official
Date
ThiS IS to certify that the request in the above application and accompanymg documents is 111 accordance with the City Zoning Ordinance and may proceed as requested, Tim document
when signed by the City Planner constltutes a temporary Certificate of Zonmg compliance and allows construction to commence, Before occupancy, a Certificate of Occupancy must be
isslIed
Special Conditions, if any
Planning Director
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372