HomeMy WebLinkAboutBuilding Permit 09-0413
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
(P.2:(0;
ADDRESS
~Sq7
[]o~ Cc;a +
Tf\
~~e ~:~ I PERMIT NO. 0 Q. o+r~
Yellow Applicant I ~ J
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER ..,...,
(Name) I 0 y./I
T leA 11
/i,s CCi ,L
II'
(Address)
:;L S-Cf 7
(Phone)
Cis;). - Lf~/-c>q 7g-
=':~Name) ~Cilr:qj ~<e- A/<:.-/~~i
(Contact Name) 73.0 d H-. (.....5
(Address) I g-y- '2e~{Q.v./ d-C/e,. ,A/
7 C]- '1))-)l.o::;:;
sc:>7- 1('7'- 0,2 35-
S-S 3/6
TYPE OF WORK 0 New Construction ODeck OPorch ~-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAIteration DUtiIity Conne~
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
ill IV V A
HIM R
2 3 4 5
o Misc:
B
S U
PROJECT COST IV ALUE $
(excluding land)
Cf. If CYo
.
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 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 revoke 's permit for just cause. Furth e, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Q~:l2?f~'1 b- :;)J-oq
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 Application Becomes Your Building Permit When Approved
Building Official
Date
Contractor's License No. Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
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 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 be
issued.
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
"l.!!I!J~akota Stn:u1i.E_..Ptim:Lake Min.."""." .c;s'"l"7"