HomeMy WebLinkAboutBLDG 07-0452
CI'fX_ OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIF TE OF ZONING COMPLIANCE
AND UTILITY C NECTION PERMIT
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LEGAL DESCRIPTION (office use only)
Date Rec' d
(,.(,.01
I While
Pink
Yellow
File
City
Applicant
\ PERMIT NO. 0 7. (J ~5z.j
ZONING (office use)
LOT
BLOCK
ADDITION
PID
\ OWNER
(Name)
(Address)
(Address)
TYPE OF WORK 0 New Construction ODeck OPorch
OAddltlOn OAlteration OUtility Conne
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
III
H
2
IV V
I M
3 4
A
R
5
(Phone)
(Phone) -r6"5-lIZ7 -9~ 96
(Phone)
ORe-Siding OLower Level Finish 0 Fireplace
o Mise.
B
S U
PROJECT COST /V ALUE
(excluding land)
$
I hereby ccrtify that I have furmshed mformauon on this appllcatllJO whIch IS III the best of my knowledge true and correct ] also certIfy that I am the owner or allthollzed agent for the
above-mentlllned pmperty and that all constructIon WIll conform to all eXlStll1g state and local laws and WIll pmceed in accordance with submltted plans. I am aware that the bUlldmg
offieral can' oke thl"(ll'lm fm lust cause Flllthermme, I hereby agree that the erry offieral or a deSIgnee may enter upon the plOpel1Y III perform necded mspectlons
za:,/OZ-77 6/6~-;Z
Contractor's License No Date
x
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
\ Penalty $
I Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $ i
This Application Becomes Your Building Permit When Approved
nuildll1g Oltlelal
Dale
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOT AL DUE $
Tim IS to cerufy thai thc ll'qllest ll1 the above applicatIon and accompany 109 documents IS 10 accordance with the City Zoning Ordinance and may proceed as requcsted ThIS document
when slgneel by the City Planner consututes a tempmary Certlflcate of Zomng compliance and allows coostrucuon tl) commence. Before occupancy, a CertIfIcate of Occupancy must be
isslIed
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (')52) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372