HomeMy WebLinkAboutZoning Permit 06-0004CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I White File
2 Pink City
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
z4 -1 aLAkE Biw-1r"ZE�z� Pre kc-
LEGAL DESCRIPTION (office use only)
Date Rec'd
PERMIT NO. 060c4--
LOT BLOCK ADDITION PID
ZONING (office use)
OWNER
(Name) 3fi,nf KJ Rr (Phone) 9 52-- `103(ca3
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re -Roofing ❑Re -Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U
Division:
1 2 3 4 5
XMlsc.
/Z 0 0S//E22
PROJECT COST/VALUE $
(excluding land)
I hereby certify that l have furnished information on this application which is to the best of my knowledge true and correct I also certify that 1 am the owner or authorized agent for the
above -mentioned 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 -voke this permit for Just cause � Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections
Signature
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 Appl' . i n Becomes Your Building Permit When Approved
8.(o�
Date
Contractor's License No Date
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
Paid
Date $, / a 6
Receip
By
This is io 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
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must he
sued
Planning Director
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any