HomeMy WebLinkAboutBuilding Permit 09-0553
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
at bottom)
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Date Rec' d
I. White File I PERMIT NO
2. Pink City . <:::J _/h r r ~
3. Yellow Applicant . --1 ""to.-' ~ ':) ;:l
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNF,R . .
(Nam ./, --1< -a--A.'"t
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(Phone) <as / - 39 P- - '-I I "3 J
(Addnss) ~~ ':1.5 _;>- s
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BUIU:m---~"-'----\ t
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(COp'll' iny Name)l~,1'~ k L r:--<10 C L) --!: I <:::!.-U\_ Q.f
~':~O\.)~I..l~':;'~L~Z .~ ;L'IO ~/JQ_,'"\
(Conl11 t Name) e U d C-l2. Y\..~. v' .R U .~
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I (Address)
7 h 3 - 5- 'IS- ~ OS S"(S-'
/
(Phone)
II) 1'\"')
U",j/tQ VI
(Phone)
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TYPE OF WORK 0 New Construction o Deck DPorch ~e-ROOfing
DAddition DAlteration DUtility Connection
CODE: l\iZ1I.R.C. DI.B.c. 0 Mise:
Type of. &struction: I II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 4 5
e-Siding o Lower Level Finish 0 Fireplace
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PROJECT COST/VALUE $J() I no () ,D D
(excluding land)
I hereby cl~rtify that I have furnished information on this application which is to the best of my knowledge true and correct. I aiso 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 accorJance with submitted plans. I am aware that
the buiIdir.g official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designe,' may enter upon the property to perform needed
inspectio~ '
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Signature
~2..1~S-~ S-
Contractor's License No.
Permit Valuation "7-5oor -
Permit Fee $ 1 4-1';-
Plan Check Fee $
State Surcharge $ (.2-('
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When
Approved
I
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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 $ 7~_ -
I Paid
Date
I Receipt No.
By
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