HomeMy WebLinkAboutBuilding 06-0366
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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
} ~ 3d (;
(2""
f;-4"1 /clIVI.
LEGAL DESCRIPTION (office use only)
LOT d--BLOCK
White
Pink
Yellow
File
City
Applicant
I PERMIT NO. Ob- 304
ZONING (office use)
::;, E
Pr ,'f/v"
L-.A- ~~
ADDITION
~5" IS '1- OJ.() 0
OWNER '-r-::
(Name) I 0('\ i
t-\ ^ qJ k-J\~
(Address)
(Phone)
~/d-I()l- 'if'7&-1o
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 io
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
III
H
2
IV
I
3
V
M
4
A
R
5
o Misc.
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby certity that I have furnIshed mformatlOn on this applicatio which IS to the best of my knowledge true and correct. I also certity that I am the owner or authorIzed agent for the
above-mentIoned property and that all <.;iIlnstruction II confor all eXistIng state and local laws and will proceed in accordance with submmed plans I am aware that the buildmg
:ficial can revoke this perm~~Ise Furth ore, I he' y agree that the City official or a deSignee may enter upon the propel1y to perform neede'S:I/;' _ ~(,
Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
~mQcrkFff $
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
BuildltH! Uftictal
Dale
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 $ IJ~.--
Paid
Date
~ to. ;;
5'- 0- to
I ~~CCiP:j'5 /'-/ /{j
This IS to certity that the request in the above applIcatIon and accompanymg documents is m accordance with the City Zoning Ordinance and may proceed as requested ThIS document
when signed by the City Planner constItutes a temporalY Certificate of Zonmg comphance and allows construction to commence. Before occupancy, a CertIficate of Occupancy must be
isslIcd
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372