HomeMy WebLinkAboutBuilding 06-0305
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
\1
....-,- \
f>)et) StJr\~
Date Rec' d
White File I ERM ~
Pink City P IT NO. 01'- - i!) '::2
Yellow Applicant , ~ _
( x:..
_J r.-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
s ~_
~r\\-\J
111 (-::</ )):V,,\
(Address)
PID
25- 'lOz.-or-d
If/O 61 fj V
no
(Phone) 1~ J-
Sf
BUILDER
(Company Name)
(Contact Name) ~') 6 ~~~ ~
(Address)
(Phone)
(Phone)
l}S).
L//O
LJoY
,
TYPE OZWO 0 New Construction ODeck o Porch ~e-Roofing
OAdditlOn OAlteration o Utility ConnedioJ
O 0 Mise
CODE: I.R.C. I.B.C"
Type of Construction:
Occupancy Group:
Division:
A
I
E
V
M
4
II
F
I
III
H
2
IV
I
3
B
ORe-Siding OLower Level Finish
o Fireplace
A
R
5
B
S U
PROJECT COST /V ALUE $
(excluding land)
I hereby certify that I have filrnishcd mformation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authOrized agent for the
above-mentIOned property and that all Cllnstruction will COnfl1fm to all eXIstIng state and local laws and will proceed in accordance with submitted plans. I am aware that the buildIng
"fficial can revoke thIS I'm It for Just cause Furthermore, I hereby agree that the CIty official or a desIgnee may enter upon the propeny to perform needed InSpeetlllns.
x
Signature
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
$
Contractor's License No,
Date
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'.-
11';;~
I ~~celPt~ '-I
Paid
Date
ThiS tS to certIfy that the request in the above applicatton and accompanY1l1g documents IS In accordance with the City Zoning Ordinance and may plllceed as requested. TIllS document
when signed by the City Planner constItutes a temporary Certificate of ZonIng compliance and allows constructIOn to commence. Before occupancy, a Cerl1ticate "fOccupancy must be
issued
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