HomeMy WebLinkAboutBuilding Permit 09-0505
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CITY OF PRIOR LAKE BUILDING fERMIT, ~ ~ l& ~q}lt~~ru
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ~ '
AND UTILITY CONNECTION PERMIT JUL 19 200Q
I White
Pink
Yellow
File
City
Applicant
ZONING (office use)
Sumrvt&r S+. N~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(~+e v-e,
~1~ S
~ ~-t/V1
Sf.NE
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) ? 0
(Phone) qt7)... -J;;"~-3sf;>....
537?-
(Phone) 7~ '3 -4 lJ.-'f-~g),
1"
(Phone)
Ml/'v1fh
Mf\J
TYPE OF WORK D New Construction DDeck DPorch Re-Roofing
DAddition DAlteration DUtility ConnectIOn
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
B
S
DLower Level Finish D Fireplace
D Mise.
U
PROJECT COST/VALUE
(excluding land)
Cj J ~(j
,
$
I hereby certify that I have furnIShed mformation on tillS 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-menuoned property and that all constructIOn will conform to all existmg state and local laws and will proceed m accordance with submllted plans I am aware that the buildmg
~Iicial can rev, 'thIs p It for JU c ,e Furthe' ore, I hereby agree that the cIty official oa:t~~ ~7-erty to perform needed ~7qn! () 1
Signature Contractor's License No. I Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Buildl11~ Ortlcial
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 $
ThiS IS to certIfy that the request In the above applicatIon and accompanYing documents IS m accordance with the City Zoning Ordinance and may proceed as requested TIllS document
when signed by the City Planner constItutes a temporary Certificate uf Zomng 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
4646 Dakota Street Prior Lake, MN 55372