HomeMy WebLinkAboutBLDG 07-1060
II ~v
Pv ~ CITY OF PRIOR LAKE BUILDING PERMIT,
~ C\ocjV TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
~ ~~"1\~ AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
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Date Rec' d
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File
City
Applicant
I PERMIT NO. 07 /0(" 0
p/C-O V Gifn /'vf /J ~ I/O .
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I OWNER
. (N,mcl
. (Address)
(Phone)
BUILDER ) , (" " ~
(Company Name) \ L- If\..: '\ \A_'\- '?.::> 0 ...... _ 1~........ c..
(Contact Name) ~ "O~ \L\A.~""- ~-\
I..
(Phone) '15).. - Re;.5 QD~\
(Phone) q"'S,). - d-\ '> - '6 d- ~ 0
(Address)
TYPE OF WORK 0 New Construction ODeck OPorch R1Re-Roofing ORe-Siding OLower Level FinIsh 0 Fireplace
OAdditJOn OAlteration o Utility Conne~ili;n
CODE: OLR.C. OLB.C.
Type of Constmction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
I hereby certify that I have turOlshed InformatIOn on this application which IS to the best of my knowledge true and mITec!. I also certify that I am the owner or authonzed agent tor the
Jb"ve-ment!(lOed PWP..,-tyailatl;-ai-arr~. ctron wtll continm to all extstmg state and local laws and wIll proceed in accordance with submItted plans I am aware that the bluldmg
llfflcial can It' iih' tlm permIt lin Just cause rthermore, I hereby agree that the CIty official or a deSIgnee may enter upon the propel1y tll pert(lrm needed InSpectllms
f -.
, \\ -5-0-1
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Date
x
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
j Penalty $
! Plumbing Permit Fee $
I
~echal11cal Permit Fee $
Sewer & Water Permit Fee j $
Gas Fireplace PermIt Fee $
This Application Becomes Your Building Permit When Approved
IluildllH! Uniclal
Date
o Mise.
B
S
PROJECT COST IV ALUE
(excluding land)
$
U
Contractor's License No.
Park Support Fee
#
$
SAC #
Water Meter Size 5/8"; \";
Pressure Reducer
Sewer/Water Connection Fee #
Water Tower Fee #
Builder's Deposit
Other
ThiS IS tll certify that the request III the abuV(' appltcatlOn and accompanYllIg documents IS 10 accordance WIth the CIty Zuning Ordrnance and may proceed as requested ThiS ducu ment
when Signed by the CIty PI,lIlner COI1.StItutes a temporalY Certificate of Zonrng compltance and allows constructIon to commence. Betelre occupancy, a CertIficate of Occupancy must bc
issued
Planning Director
Special Conditions, if any
Date
24 hOllr notice for all inspections (952) .t.t7-9850, fax (952) .t.t7-.t2.t5
4646 Dakota Street Prior Lake, MN 55372