HomeMy WebLinkAboutBuilding 08-0388
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
ILfS-3g
n at bottom)
Date Rec' d
] White
Pink
Yellow
I PERMIT NO.OB - SBB I
File
Cily
Applicant
ZONING (office lIse)
Sy RR.EY
LN. JJE
fJ.-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
C Uf( rJ S 8LACK
/LJ. SVf?AEY LN.
(Address)
BUILDER
(Company Name)
PID ZS'...300-o(1"O
(Phone)
f~/OR
lAkb
LI-C
TYPE OF WORK o New Construction ODeck OPorch Re-Roofing ORe-Siding o Fireplace
DAdditlOn DAlteration o Utility ConnectIOn
CODE: DI.R.C. DI.B.C. o MIse.
Type of Constnlction: I II III IV V A B $ 9; 000 e..e.
PROJECT COST /V ALUE
Occupancy Group: A B E F H I M R S U {excluding land}
Division: I 2 3 4 5
I hereby certify that I have furmshed mformation on this applicatlOl1 which IS to the best of my knowledge true and COlTect I also certify that I am the owner Dr <luthonzed agent for the
ahow-mentlOned property and that all constrllctllln wlll conform to all eXlstmg state and local laws and will proceed in accordance with submItted plans I am aware that the hlllldmg
ofljeial ca r' lke thIS permit for JUS ~sc Furthermore, I herehy agree that the City official or a deSignee may enter upon the propo1y to pert(Jrm needed mspectlons
Xt:7-~ --~-~ t106J.9e,:;LJ. _~~)/"]er
SIgnature Contractor's LICense No. Da~
Permit Valuation
Permit Fee
$
$
$
$
$
$
I $
$
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
~echanical Permit Fee
Scwer & Water Permit Fee
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connectton Fee # $
,
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ ~....r
tirJ 06
I ~~ceiPt ~-o
Paid
Date
ThIS IS to certify that the request m the abow apphcatIon and accompanymg documents IS m accordance with the City Zonmg Ordmance and may proceed as requested ThiS document
when signed by the City Planner COI1"itItutcs a temporary Certifi.cate of Zonmg compliance and allows construction to Cllmmence Before occupancy, a Certlfi.cate Df Occupancy must be
Issued
Planning Director
Special Conditions, if any
Date
24 hOllr notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372