HomeMy WebLinkAboutBuilding Permit 03-0257
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
/5283 r/f/ted/lN/<-S
LOT q BLOCK
LEGAL DESCRIPTION (office use only)
I. White File
2. Pink City
3. Yellow Applicant
Pl..-0
ADDITION n/fP&b t?/G .f/~~
OWNER
(Name)
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
~E-N }O,Je:" o'-2ES {L)Aig-tIl...~(Ti njJ
K...c: ... \ }: t'L-, ~ 'l) "'" It:. <..,
(Phone)
(Phone)
TYPE OF WOR!< CLOSE FILE
10/28/03 MP
o Misc.
o Porch
~e'RoOfing
o Alteration
Date Rec' d
..3- / 0 -03
PERMIT NO'()3_ 0257
I
ZONING (office use)
Jet J ..0
PID z..-r - 03 t, - oaY- 0
95Z- - q'l7 - 1/132-
ORe-Siding
OUtility 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 upon the property to perform needed inspections.
x
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
Signature
'2~5 tJO..OV
$ , 7c/1,J
$ .-----
$ I.z,r
$
$
$
$
$
This APPliCatiO~ :~oX. es Your Building Permit When Approved
f IfiJ" ~ . 10'03
Building Official Date
ace
OAddition
Date
# $
# $
$
$
# $
# $
$
$
~ '7/0. fJO
I )1
Receid ~ n?i1f?6
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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
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director
)ST/VALUE (excluding land) $
Contractor's License No.
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
I Paid )~ rVV
I Date J r / 0 .. ()J
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372