HomeMy WebLinkAboutBuilding Permit (LL) 08-0978 (2)
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PERMIT NO'08. 09
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I White
Pin!.;
Yellow
File
City
Applicant
(Please n at bottom)
ADDRESS
/&,20 I TAH 1A/JG,q
;QL.-fC) ec
Date Rec' d
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
ADDITION
PID 2S, 469. 003. 0
BLOCK
OWNER
(Name)
(Phone)
(Address)
~/2.. 25D. ~7(P
BUILDER
(Company Name)
(Contact Name)
(Address)
/'1jCJN~Y
J::;t/ /C1
7 (, ~ S Oc..l77T~.LJ
#2..C ~
(Phone)
(Phone)
IS/VI
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAdditton OAlteration o Utility Connectton
CODE:~.R.C. OLB.C.
Type of~truction: I II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 4 5
ORe-Siding
ower Level ftnIsh
2 IU4(S.
o MIse.
PROJECT COST/VALUE $
(excluding land)
o Ftreplace
I. hereby certity that I have hlrmshed 1I1formatl<ln on thiS application which IS to the best of my knowledge true and CllrreCl I al.so ccrlify that I ilm the owner llr ;\uthollzeLl agent telr the
ahllVl'-mclltlOlled property and that all Clmstruction will conform to allexistmg state and local laws and will proceed In accordance with submItted plans 1 am aware that the htllldmg
nftlClitl can revoke thiS permit for Just cause Furthermore, I hereby agree that the city official or a deSIgnee may enter upon the propelty to pert(Jfm needed inSpectIOns
x
Signature
Contractor's License No.
Date
Permit Valuation
#
#
Park Support Fee
SAC
#
#
Permit Fee
$
$
$
$
$
$
Builder's Deposit
Other
Plan Check Fee
Water Meter Size 5/8"; I";
Pressure Reducer
State Surcharge
Penalty
Plumbing Permit Fee
Mechal11cal Permit Fee
Sewer/Water ConnectIOn Fee
50.00
Water Tower Fee
Sewer & Water Permit Fee
--
TOTAL DUE
$
$
$
$
$
$
$
$
$
4 honr notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any