HomeMy WebLinkAboutBLDG 08-0358
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
~./O ,00
(Please type or print and sign at bottom)
[ADDRESS
/ Lj ,,<-> /1
I White
Pink
Yellow
File
City
Applicant
\ PERMIT NO. O~. 03 S-~
ZONING (office use)
/5rld lr .e~f {'.J
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(N ame)
(Phone)
(Address)
BUILDER t. " Ie
(Company Name) ;;;..; ~'h/)/t' P Lf/4.'"'t Ie r r
(Contact Name) ..:st, ~ , L "~ yY1,.g \1" 1 l (
(Address) ~3oq{'; '(
TYPE OF WORK 0 New Construction ODeck OPorch
DAdditlon DAlteration DUtility Conn
ZJ1<: .
-
(Phone) (p I ::r Cjt / - tt rC/, S
ORe-Siding DLower Level FinIsh D Fireplace
CODE: OLR.C. OLB.C. DMisc --
Type of Construction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
I hereby certity that I have hlfnlshed mtmmatllm on this application which IS III the best of my knowledge true and mrrect. I also certify that I am the owner or authonzed agent Illt'the
J.boYC-mcntlOncd property and that ;lll cnnstruction w1l1 confnrm to all existmg state and local laws and will proceed in accordance with submitted plans 1 am aware that the buildIng
()ftIcial can revo' lIS pcrmlt for Just cause Furthermore, 1 hereby agree that the City l)fficial or a deSignee may enter upon the propet1y to perform needed 1I1spectlllns
- L.r--
x
Signature
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
I Plumbing Permit Fee $
Mechanical Permit Fee $
Sew" & W",,, P,nn" Fee =:j $ \
$ I
Gas Fireplace Permit Fee I
This Application Becomes Your Building Permit When Approved
nllildll1g UIlicial
Date
~)l '7917,<)
Contractor's License No,
t:,- ;c._(') ?(
Date
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
ThIS IS to certify that the request in the above applicatlon and accompanymg documents is 111 accordance with the City Zoning Ordinance and may procced as requested. ThiS document
when signed by the City PI,u1l1er Cllnslltlltes a temporary Certiftcate of ZOl11ng compliance and allows nmstruCllon III commence Before occupancy, a Certlticate of Occupancy must he
isslled
Planning Director
Special Conditions, if any
Date
24 hOllr notice for all inspections (952) ~~7-9850. fax (952) ~~7-~2~5
4646 Dakota Street Prior Lake, MN 55372