HomeMy WebLinkAboutBuilding 06-0472
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
Go. 5. ob
at bottom)
ADDRESS /~Z.80 L.,O/S
/9 t/e.
I White
Pink
Yellow
File
City
Applicant
\ PERMIT NO. 0 e:, . 04 7~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER...-r"
(Name) I' QLf> '3
(Address)
L. Le~
(Phone)
9.50 - LjIfO - 374-::':> I
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch e-Roofmg ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Conne tJon
CODE: OI.R.C. OI.B.C. o Misc.
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 certifY that I have furmshed mfmmatlOn on this applicatllln which is to the best of my knowledgc true and cmrect I also cernfY that I am the owner m authoflzed agent for the
above-mennoned property and that ,11 construction will conform to all eXlStmg state and local laws and will proceed in accordance with submitted plans I am aware that the buildmg
"lfiClal can revoke thiS pelmlt for Just cause FlIlthelmme, I h> eby aglee at the City offiCial 01 a deSIgnee may enter upon the plopel1y to pel form needed mspectHlns
X & . ~ f.rJ-S-()~
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 Permit When Approved
Building Otlieial
Datc
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ '7~. ~()
-,
Paid
Date
~(,. ~ 0
.S fI'
Jj.CiPt No.
b15~J
ThlS IS to certifY that the request'" the above apphcatlOn and accompanymg documents is 10 accordance WIth Ihe City Zoning Ordinance and may proceed as requcsted. ThiS document
when signed by the City Planner CLlnstltutes a temporary Certificate of Zonmg compliance and allLlws construction to commence Before Llccupancy, a Certiticate of Occupancy must be
isslIed
Planning Director
Special Conditions, if any
Date
24 hOllr notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372