HomeMy WebLinkAboutFence Permit 05-0027
CITY OF PRIOR LAKE BUI RMIT,
TEMPORARY CERTIFICATE ~ONIN~OMPLIANCE .
AND UTILITY CO o'rH't.1iMIT
Date Rec' d
<;? IS-. oS
1, White File
2. Pink City
) Yellow Applicant
I PERMIT NO. OS, cd 7
(Please tYPe or print lUld sip at bottom)
Au.....AESS
157 J J ,SeLf 1/fee (/i'( 5[
ZONING (office \lie)
K.I
LEGAL DESCR.u: uON (office use only)
LOT 7 BLOCK 3 ADDITION /1/0 /C/m ?/c.../ OK- / Jr
PID zS-: () 58. ()/3. 0
OWNER
(Name)
(( oCltr t AJ1n (fa Id
1
/(.71 J J ~Jt{/vtfee err 5(/
(Address)
BUlLv.r..a<.
(Company Name)
(Contact Name)
. (Address)
(Phone)
t.flfO' ~/q 1
Self
(Phone)
(Phone)
t.( tfl9 . (t/q b
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Fimsh 0 Fireplace
DAddition DAlteration OUtilityConnection ~Misc. t:h"-iVl /ltt.t-fCl'1<e- 4' tlJ&H
. CODE: OI.R.C. OI.B.C. PROJECT COST/VALUE S
Type of Construction: I n m IV V A B (excluding land)
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 4 S
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 tM owner Ill' authonzed agcnt for the
aboY.e.menl1on,~ .'..r"-_ and that onstruction will inform to aU existing state and .local laws .and will r,.---J in accordance with submitted plans. I am. awarc tha. t the building
offICIal can.. 1..1.. IS permit for J cause. Furth ore I hereby agree that the CIty official or a des1gl1cc may enter upon the ~_.~ ,. ~,' to perform needcd IllSpCClIOnS.
X '-- - ~.(~)"
C Signature \ I Contractor's License No. / Date
. ..,..-...-"..... .,-=-; "i \'---../
PukSu~F~ # $
SAC # S
I Water Meter Size 5/8"; I"; S
I Pressure Reducer S
Sewer/Water Connection Fee # S
Water Tower F~ # S
S
S
S
I Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
A
$
S
1$
S
$
S
S
S
I Builder's Deposit
Other
f-./O
I "41' t:.r
f , V
V '
TOTAL DUE
your.Buit. dmIP~7enZ.~d
I~ 1 ItZ
I Paid
I Date
I Recei"t No.
Bv
ThIS is to certify that tM request in the above application and aeeompanying documents is in accordance with the City Zoning Ordinance and may proceed as requl'Sted. This document
when signed by the City Planner constitutcs a temporary Certificate of Zoning compliance and aUows construction to commence. Before occupancy, a Cl'tliflcatc of Occupancy must be
issued
PIanning 1::'. ....
Date Special Conditions. if my
24 hour notice for all inspections ('P.I2) 447-98~. filii (~2) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 55372