HomeMy WebLinkAboutBLDG 07-0195
ITY OF PRIOR LAKE BUILDING PERMIT,
"'/TEMPO Y CERTIFICATE OF ZONING COMPLIANCE
. ~ ~~, ~ A D UTILITY CONNECTION PERMIT
c;/?cr I t7B iJ ~
Date Rec' d
ill I /07
1 White
Pink
Yellow
File
City
Applicant
PERMIT NO. 07 - 0 I 'IS-
(Please
ADDRESS
IlllB
.~C;~ S
ZONING (office use)
::C()~ ell- SL.0
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
L€olUA^JJ
11 '7 ~
1vJ(....)t 1"-
.:lair <YL-sw
(Phone)
9S~- (-l'io-w8~'f
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
..--
I vrf
S~
(Phone)
(Phone)
TYPE OF WORK 0 New Construction OOeck OPorch ORe-Roofing
OAddition OAlteratlon OUtility Connectlon
ORe-Siding
OLower Level FinIsh 0 Fireplace
CODE: ~.R.C. DI.B.c. l3Misc
Type of onstnlction: I II III IV V A ~€)
Occupancy Group: A B E F H I M R
Division: I 2 3 4 5
/J..'
)( ( J... '
S f'1G6
PROJECT COST IV ALUE $
(excluding land)
I hereby certify that 1 have hlrmshed Informallon on thIs applicallon which IS to the best of my knowledge true and wrrect I also cerllfy that I am the owner ()I ilutlwnzed agent I'll the
allllve-menllLlned property and that ,Ill constructllJn will confmm III all eXIstIng state and local laws and will proceed in accordance with submitted plans I am aware thill the blllldIng
"ffleiill can revok ' s :-mll for p C"{2. Furthermore, I hereby agree that the Clt)' official or a deSIgnee may enter upon the propel1y (() pedcllm ne::( InS ;;"ns
Signature
Contractor's License No.
Gas Fireplace PermIt Fee
-
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit i $
Other $
TOTAL DUE $ 7&;e OD
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
,z.-~
Sewer & Water Permit Fee
This Application Becomes Y OUT Building Permit When Approved
~ ~ f/ll/d7
Buildlllg Urtlcial Dat! J
Paid
Date
~~~ .b.
/, 7
/
Receipt No. ~g Z- ~ ~
By ~
This IS to certify th;lt the request in the above application and accompanYll1g documents is lt1 accordance with the City Zoning Ordinance and may proceed as requested. ThiS document
\vhco signed hy the City Planner constitutes a temporal)' Certificate of ZOl1mg compliance and allows construction to commence Bcfnrc occupancy, a Certificate of Occupancy must he
i'ssued
Planning Director
Special Conditions, if any
Date
24 honr notice for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372