HomeMy WebLinkAboutBUILDING 08-0599
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF WNING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
t'. /I 6 f)
1. White- File I I
2. Pink City PERMIT NO. /)c: C;.~jC11
3. Yellow Applicant . G (, _ .
ZONING (office use)
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7 Ol/v~ Sf t'Uf Sf, mt/2 {,frICe
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
Jdtpb f N~bt{tA- A/a;r
41tJ1-1 7~v ~fruf i.~.
(Address)
(Phone)
q-St1- S' " 'I-DO 1- <6
f/n'err ~
Bun..DER
(Company Name) tJe';lJ.~ ~j{
(Contact Name)
(Address) '() g f/;,-rtlJ tJ ~..,
KtntolL /,41 /" t!-.
-
'1~;; ~ 1'~~ - (,69tJ
(Phone)
(phone)
Si<a.~~e , 14-1IV .s~3T?
I TYPE OF WORK 0 New Construction ODed: OPorch
OAddirion OAlteration OUtility Conn
OLawer Level Finish 0 Fireplace
CODE: ~R.C. OI.B.C. o Mise:
Type or€ truction: I n m IV V A B
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5
I hereby certify that I have furnished iotllonnation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned and that all construction Wl11 conform to an e:.isting state and localIaws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this it for just c:ause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
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Ix
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Permit Valuation
Permit Fee $
Plan Check Fee $
I State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Buildin Official
Date
PROJECT COST/V ALUE $
(excluding land)
Date
Park Support Fee # $
SAC tI- $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE /J $ 7& _ C ()
7
Paid "/~ u-Z-; I Reec7 utNo, -;z.,s-4 7
Date Z./t,c'{ I By ,
(
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
I :~~~d by the City Planner coruititutes a temporary Certificate of Zoning compliance and allows constructIon to commence. Before occupancy, a Certificate of Occupancy must be
Planning Director Date Special Conditions, if any
24 !lour notice for all iRSpecttons (952) 447-9115tl, fax (952) 447-4245
4646 Dttkotll Street S,E., Prior Lllke, M1nnesotll 55372