HomeMy WebLinkAboutBuilding Permit 09-0660
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
8 . z, 8. 07
at bottom)
41 p.. r
(l~e6 01-. SE""'
Date Rec' d
~. ':~e ~::y I PERMIT NO. 0'1. 0(, (PO I
3. Yellow Applicant
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) fYI ; ("-~ fYl ~ 1l.Q,.-
(Address) 8 ~ ~ <. So .?!.-hv v..-..J
(Phone) 95 ~ - t;:~7 - 77 7 r
BUILDER
(Company Name) M I fUN e; Sc:51,4. W J to Oo~ ~t) <SI D 110 C-
(Contact Name) Eu i
~~,....~ tJ Xi
r
(Address) L ..., (D
~
=#- 29'0
(Phone)
71c3 -sc...f~ - OS <../.5:-
/'
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
o Addition o Alteration OUtility Connection
CODE: DI.R.c. DI.B.c. o Mise: W~n~.s
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECTCOST/VALUE $ 75CJ{) .0<::)
Division: 1 2 3 4 5 (excluding land)
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 this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed
inspections.
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
dC)~q~ 5'fD S
<f-;t/-o~
Date
Contractor's Ucense No.
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
~;'7
I if' No G'f:,7 {, /