HomeMy WebLinkAboutZoning Permit 05-0003
CITY OF PRIOR LAKE BUILDING P~RMIT,
TEMPORARY CERTIFICATE O~~MPLIANCE
AND UTILITY CONNECTION PERMIT
-5-720
C/I~/Nri L
/2-f .D a-l~;:
Date Rec' d
White File
Pink City
Yellow Applicant
7. /1, 05-
-EOAJ/M
05.03
77?C.-.
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT :L BLOCK 3
ADDITION
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(Address)
(Phone)
9.:8 -Yo/ 04
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection
CODE: !!lI.R.C. DI.B.C. ~MiSC. /0 )( /2- SHED
Type of nstruction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
x
I hereby certifY that I have furnIshed Information on this application which is to the best of my knowledge true and correct. I also certify that I am thc owncr or autlwnzcd agent ItJr thc
above-mcntloncd property and that all construction wlII conform to all eXIStIng state and local laws and wiII proceed in accordance With submItted plans. I am "ware that the buildIng
omclal can revokc thIS rmlt D r Just cause Furthermore, I hereb gree that the City official or a deSIgnee may enter upon the property to perform needed InspectHlI1s
7-/9-t:?..5
Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
pplication Becomes Your Building Permit When Approved
~.tU
BuildllH! Ofllcial
7/to/o5"
Date
Contractor's License No.
Park Support Fee
SAC
# $
# $
$
$
# $
# $
$
$
$
Receipt No.
By
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Paid
Date
ThiS IS to certify that the requcst In the above applicatIon and accompanYIng documents IS in accordance with the City Zoning Ordinance and may proceed ,IS requested. Tim documcnt
when signed by the City Planner constItutes a temporary Certificate of ZonIng complIance and aIIows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
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