HomeMy WebLinkAboutBLDG 07-1092
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CI OF PRIOR LAKE BUILDING PERMIT,
.11 TEMPORAR CERTIFICATE OF ZONING COMPLIANCE
C!. oC"~ ~ t-~' \.e AN UTILITY CONNECTION PERMIT ~
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at bon
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Date Rec' d
/1. 9.1)1
1. Wltite
1 Pink
1 YeUow
~ERMIT NO.
File
City
Applica,'t
07.I0.9LI
/
ZONING (olliCl' USt!)
(,rtLL
~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(-11\ or VJ.
'214
l-v -.t "" \t,Q. v
.' .~.K t.-- VI.. ~..j
(Address)
BUILDER
(Company Name)
(Contact Name) df (/
(Address)5&lfl Ilemor/a-l /A,. /y.
TYPE OF WORK DNew Construction
DAddition OAlter-ation
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
ill IV V A
HIM R
2 3 4 5
PID
(Phone)
if r 2-447-SrS'3
(,I- (. &...
(Phone) uGI'~?J9. .tf3X)
(Phone)
}
/17.# ,j-SLl 8' ~
OLower Level Finish 0 Fireplace
B
S U
PROJECT COST IV ALUE S
(excluding land)
)J 17[-
J herrhy certify that I have furnished infonnation on this application which i.s 10 the best of my Icnowledg. true and correct. I also certify tbat I am the: own<'f or authorin'd agent for the:
ahove.mentloned ","",,"rty and that aU construction will conform to all exi.stil1J star. and local laws and will pro=d in accordance with submitted plans. I am aware that the building
official can revoke lhi$ pctmit for jU51 e. Furthermore. I hereby agree that the city official or a designee may enter upon the proJl"rly to perform needed in'J'Cctions, ,
'-/It '<-U ;;J-fJ c/ 'i if'/' ~ ~ I D / .3 D /0 7
Signature Contractor's License No. Date
x
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Y DIU Bulldlnll Permit When Appron'
BuildiOlt Officiol
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 $ 7&-
I Paid
Date
,(1
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./
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ThIS is to cenify that thc request in lhe ahove application and accompanying document! is in accordance with the City Zoning Ordinance and may pr~ed as requested. This document
when signed by the City Planner eon.nitutes a temporary Certilkate of Zoning compliance and allows eon51",ction to rommenCl'. Before occupancy, a Cl'f1irlCllle of Occupancy must be
wued
I
Planning Director
Date Special Conditions, If any
24 hour notice for an Inspection. (9~2) <<7.98~. fax (~2) 447--424!1
16200 Eagle Creek Avenue Prior Lake. MN 55372