HomeMy WebLinkAboutSign Permit 98-03 H & R Block
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City of Prior Lake
APPLICATION FOR SIGN PERMIT
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Permit No. 9 ~ -03
DIRECTIONS: Spaces numbered 1 thru 10 must be filled in before permit is issued
(Please print or type, and sign where required
1. PARCEL NO. OF PROPERTY:
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2. APPLICANT: (NAME)
(ADDRESS)
(PHONE)
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5. TYPE OF SIGN: TEMPORARY (21 DAYMAXIMUMDISPLAY) ~ANE~ALiJ!JARQUEE/AWNINGIF. 'ESTANDING)
Balloon * Bannerr:rrusi~hangeable Copy Sig~*Construction Signs*Illununated Signs nstitutional Signs*Lake Servicef;igns*
Multiple Residential Nameplate Signs*On-Premise Di,rectional Signs*Permanent Window Sign*Portable Sign*Subdivision I(entijication Signs
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6. SIGN DIMENSIONS
(square feet)
I
(Height)
2.
(Width)
15
(Depth)
2 v.,cn
10. Estimated Value of Sign
7QO~,
11. Completion Date / -9 - 9 r
7. TYPE OF CONSTRUCTION
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SIGN PERMITS WILL NOT BE PROCESSED IF THEY ARE INCOMPLETE
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I hereby certify that I have furnished information 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 construction will conform to all existing state and local laws and will proc"eeeedd~', ' rdance
with submitted plans, I am aware that the Ci er can r ke this permit for just cause. Furthermore, I hereby agree that City Offi~"or a"1Iesignee
thereof may enter upon the property to pe neede inspe is"
FOR ADMINISTRATIVE USE
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SUBMISSION REQUIREMENTS
I / ~mpleted Application
~' lli", ing showing location of sign
ans and Specs 00
_ Permit Fee '$ 30 (permit fee is set
at time of application according to approved schedule)
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This Application b
By
City Planner or designee
Date J)q) 9 g
This is to certify that the request in the above application and accompanying documents is in accordance with the City Sign Ordinance and may proceed as
requested. This document, when signed by the City Planner or designee constitutes a temporary Certificate of Zoning compliance and allows construction to
commence. "..
Special Conditions
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24 Hour Notice ttr All Inspection~\
447-4230 from 9:00 a.m. - 10:00 a.m,
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Received of
CITY OF PRIOR LAKE
16200 EAGLE CREEK AVE SE
PRIOR LAKE, MN 55372
(612) 447-4230, (612) 447-4245
RECEIPT # 31918
DATE)!q I'iK
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dollars
$
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BUILDING PERMIT #
Building Permit Fee
Plan Check Fee
State Surcharge
Plmb Pmt pp#
Mech Pmt mc#
(Heating only - $65.00)
(Htg & Air - $100.00)
(Fireplace - $40.00)
(Air - $40.00)
Swr/Wtr Pmt sw #
Other
Total
BUILDING PERMIT #
1',200.00
700.00
1,500.00
. P POLLOCK TRUCKING
20321 CEDAR VALLEY ROAD
JORDAN, MN 55352
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VALLEY BANK MINNESOTA
JORDAN, MN 55352
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Building Permit Fee
Plan Check Fee
State Surcharge
Park Support Fee
SAC
Plmb Pmt pp#
Mech Pmt mc#
Mech Pmt mc#
Swr/Wtr Pmt sw#
Pressure Reducer
Water Meter
Tree Preservation Deposit
Swr/Wtr Connection Fee
Water Tower Fee
Builder's Deposit
Other
Total
75-1195/919
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