HomeMy WebLinkAboutBuilding Permit 03-0161
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
F/ Le wi
03 - {)O /2.....
I. White
2 Pink
3. Yellow
File
City
Applicant
I PERMIT NO. 03-o/ftJ/l
(Please '!ype or print and sign at bottom)
ADDRESS
r73&,o ~,J/~/d 'r:>rtV( ),C
LEGAL DESCRIPTION (office use only)
/7 brc/! 91t,
LOT BL6cK ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER \
(Name) jJ, 12. /~vh~
(Contact Name) -:JC~<;;L''' f!,f",k5-
(Address) ,;;l{)'j(t,() /4.'/'McI<:/ (4~,i
Date Rec'd
I ZONING(officeuse)
(Phone)
(Phone) tjS.2, Y?'5- 7 tTO if
L"lul/,J/~ /1fA/ .s3z;rr
TYPE OF WORK
o New Construction
~ower Level Finish
ODeck
OPorch
OAddition
ORe-Roofing
o Fireplace
DAlteration
o Misc.
PROJECTCOST/VALUE (excluding land) $ 1</77"-
ORe-Siding
DUtility Connection
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 u~on)Jf pr9pe,>>to,ge*rm n~edef i~~'j'f~ns
X /'XhL~ ~ '?OlJQ'R,S 7 /- W-c?
~r - Signature Contractor's License No. Date
I Permit Valuation 1oo0.(JO Park Support Fee #
I Permit Fee $ , 7'1 . 7S" SAC #
I Plan Check Fee $ I Water Meter Size 5/8"; I";
I State Surcharge $ / ..::>-V 1 Pressure Reducer
I Penalty $ I City SAC and WAC #
I Plumbing Permit Fee $ tjt) .00 I Water Tower Fee #
1 Mechanical Permit Fee $ I Builder's Deposit
I Sewer & Water Permit Fee $ I Other
I Gas Fireplace Permit Fee $ I TOTAL DUE
?Jr:{7!1::.ur Building pe;~:;;oved
Building Official Date
I Paid
I Date
7ItI1~, d-51
::J- 7-~
$
$
$
$
$
$
$
$
$ //~- 2.5
Receipt No, t-I:3I1'i6
r
Bv
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
:::e~SiJ:l)l_7Z13:mt" a tempo'~ Ceruficate o~~;_c;~ance and allows cone:: ~om7.0_::~cru~::~ertill~t=:~t be
pfanning DIrector Date Special ConditIOns. if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
, ,