HomeMy WebLinkAboutBuilding Permit 04-1187
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
White
Pink
Yellow
File
City
Applicanl
I PERMIT NOt)/I_/ I g/f
at bottom)
ADDRESS
ZONING (office use)
l ~ (~
A/C-
LEGAL DESCRIPTION (office use only)
LOT L BLOCK
ADDITION
PI
35' LX>,;2- I
OWNER
(Name) J(.~~
(Phone) QSZ J'CjtJ,. /:',3 (..t.1
(Address)
BUILDER
I (Company Name) ::'!!t::'L/::::; ~'-' c,i:
(Contact Name).. . "_ t? /. ~.A':. ..
(Address)
(Phone)//- 71!:'--3g-i- ID;~ G.-
(Phon~ t"S/ -/"'?4Z" L'..~~Cj ~7
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ~Re-Siding OLower Level Finish 0 Fireplace
DAddition o Alteration OUtility Connection 0 Mise.
f )~5-C'O .. OC:-.
CODE: DI.R.C. DI.B.c. PROJECT COST/VALVE =---
Type of Construction: I II III IV V A B (excluding land)
Occupancy Group: A B E F H I M R S V
Division: 1 2 3 4 5
I ereby certify that I have furnished 1Oformal1on on this application which IS to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
above-m n -0 CITy and that all construction will conform to all eXlst10g state and local laws and will proceed in accordance with submitted plans. [am aware that the build10g
o LCia] can rev his 'mlt for. ust cause Furthermore,] hereby agree that the City official or a designee may enter upon the property to perform needed 1OspectlOns.
-/I /C) 0/ ?r;97
Contractor's License No.
~
,# p./?C A'" /"1n'_5-'
Date
x
Permit Valuation
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 7~' -
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 Your Building Permit When Approved
Paid
Date
7t~::/:-r2<j I ~::~o I/NCJ q I
Date
13uild11l!!. Official
ThIS IS to certify that the request 10 the above applical10n and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested. ThIS document
when signed by the City Planner constitutes a temporaty Certificate of Zonmg compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must be
issucd
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372