HomeMy WebLinkAboutBuilding Permit 09-0674
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
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White
Pink
Yellow
File
City
Applicant
\ PERMIT NO. ~9, 0 ~ 11-1
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
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(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) f';
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TYPE OF WORK 0 New Construction ODeck OPorch p(Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration OUtility Connection
CODE: OJ.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
III IV V
HIM
234
A
R
5
I hereby certify that I have furnished mformation on this application which is to the best of my knowledge true and COlTect. I also certify that I am the owner or authonzed agent for the
above-menuoned property and that aU construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this permit for Just caus Furthermore, I hereby a ee that the City official or a designee may enter upon the property to perform needed mspecuons.
q - 2 - t?q
x
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
Date
o Misc.
B
S U
PROJECT COST /V ALUE
(excluding land)
$ I C(f
~ f Z-
Contractor's License No. 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 $ -
Buildin!! Ot1icial
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 dllcument
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate llf Occupancy must be
issued
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372