HomeMy WebLinkAboutBLDG 08-0320
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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Pink
Yellow
I PERMIT NO. Y 032 c1
File
City
Applicant
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
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PAvI
(Phone)
(Phone)
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2d9- 5'/3/
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility ConnectIon
CODE: OLR.C. OLB.C. o Mise,
Type of Constmction: 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
1 hereby certily that I have turl1lshed ml()rmatlOn <lI1 this applIcatIon which IS to the best of my knowledge true and CDrrect 1 also certify that I am the owner or authonze,l agent lor the
JbllVC-mcntlOl1cd property and that all construction WIll conform to allexlstmg state and local laws and will procecd in accordance with submitted plans_ I am awarc that the buildIng
official can revoke thiS permIt for Just CJuse Furthermore, 1 hereby agree that the city official or a deSignee may enter upon the prOpCJ1y to perform needed inspections
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Signature
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
i Penalty $
Plumbing Permit Fee $
MechanIcal Permit Fee i $
Sewer & Water Permit Fee I $
Gas Fireplace PermIt Fee $ I
This Application Becomes Your Building Permit When Approved
lluildlllg Ut1lelal
Date
Contractor's License No.
Date
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water ConnectIOn Fee #
Water Tower Fee #
Builder's Deposit
ThiS IS to Ct'rtity that the request in the above applicatwn and accompanY1l1g documents is 111 accordance with the City Zoning Ordinance and mtty proceed itS requested ThiS document
when signed by the City Planner constItutes a temporary Certificate of Zonmg complIance and allows constructIOn to commence. Before llccupancy, ;1 Certiticate of Occupancy mllst be
isslIed
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372