HomeMy WebLinkAboutZoning Permit #05-03
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
at bottom)
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ADDRESS
"II i.j Y
Date Rec' d
I White File
2 Pink City
3 Yellow Applicant
f\.!\. 4-. 25. oS
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I PERMIT NO. 05. 03
nlG
ZONING (office use)
I? /50
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25. 032.. OD3. 0
OWNER )
(Name) fJfu!J.{) CARt) L
IE. 'If. t.rnANtI
(Phone)
95:1- Lj CJ7 -.3 'I r ...l-
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
o Fireplace
TYPE OF WORK 0 New Construction DDeck OPorch ORe.R~ng ORe-Siding DLower Level Finish
OAddition o Alteration OUtility Connection ~ Misc. re;fV' C!A:::
CODE: DI.R.C. DI.B.c. PROJECT COST/VALUE $
Type of Construction: I II III IV V A B (exclnding land)
Occnpancy Gronp: A B E F HIM R S U
Division: 1 2 3 4 5
I hereby certifY that I have ti.trnished information 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-menl1oned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this permit for Just cause. Furthermore, I hereby agree that the CIty official or a designee may enter upon the property to perform needed mspections.
X a~ k~~ 4/,;),5/05
Signature Contractor's License No. Date
Permit Valuation
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 Pennit When Approved
Date
Building Otlicial
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $ /
TOTAL DUE $ (/)
/
Paid I Receipt No. ,
Date I Bv
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 requcsted. This document
?7\d b=ily Planner conSl1tutcs a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Cerl1ficatc of Occupancy must be
~m{~ -0 5
Planning Director Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372