HomeMy WebLinkAboutFence Permit 05-0009
Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I White
Pink
3 Yellow
File
City
Applicant
(Please type or print and sign at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT4- BLOCK.:J ADDITION IN tlltw5
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PERMIT NO. 05 ~ r:If
ZONING (office use)
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OWNER '/
(Name) J\ \:i'"'" -\
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(Phone) ( <7 <:>-l.~
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(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch o Re-Roa(1ng
OAddition o Alteration OUtility Connection ~'MiSC.
CODE: DI.R.C. DI.B.C.
Type of Constmction:
Occupancy Group:
Division:
ORe-Siding
OLower Level Finish
o Fireplace
$
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F
1
III IV
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PROJECT COST IV ALUE
(excluding land)
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I hereby certify that I have furnIShed mformation on this application which IS to the best of my knowledge true and correct. I also cerl1ty that I am the "wner or authonzed agent for the
abovc-menl1oned plOpel ty and that all cOnStlU~lOn Will conform to all eXlstmg state and local laws and Will plOceed m accordance With submitted plans I am aware that the blllldmg
otlrm can revoke thIS per;nlt f9r J)!,t cause Fu thelmOle, I hjbY a&ree that the City offiCial 01 a deSignee may enter upon the property to perform needed mspecl10ns .
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Blgnature Contractor's License No kate I
Permit Valuation
Park Support Fee
Permit Fee
$
$
$
$
$
$
$
$
SAC
Water Meter Size 5/8"; I";
Pressure Reducer
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid
Date
13uildJllg Official
Date
# $
# $
$
$
# $
# $
$
$
$
Receipt No.
By
ThiS IS to certify that the request in the above applical10n and accompanymg documents is m accordance with the City Zoning Ordinance and may proceed as requested ThIS document
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Planning Director J Date' Special Conditions, if any
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
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