HomeMy WebLinkAboutBuilding Permit 03-0266
(Please type or print and silm at bottom)
ADDRESS
Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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LOT / BLOCK I
LEGAL DESCRIPTION (office use only)
ADDITION //Ja1!J2wd &~;;; v:t
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OWNER
(Name)
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(Address)
BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
o Misc.
CLOSE FILE
[ 10/28/03 MP
[
I. White File
2. Pink City
3 . Yellow Applicant
(Phone)
(Phone)
(Phone)
'orch
ORe-Roofing
PROJECT COST IV ALUE (excluding land) $
~ddition
DAlteration
I PERMIT NO,t?.3- ~&~ I
ZONING (office use)
PIS 0
PID ,:}5 / 13~'" 001-0
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I
~e-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 ilding official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon thr~ to perfi ed inspections.
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I Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
I
I
I
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This Application Becomes Your Building Permit When Approved
Building Official
Date
Contractor's License No.
I Park Support Fee
I SAC
I WaterMeter Size 5/8"; I";
I Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
I Other
I TOTAL DUE
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I Paid ..:,p / \0' ~
I Date :5-II~
Date
# $
# $
$
$
# $
# $
$
$
$ 7(., .DO
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Receipt No. Cj i./ 00 I
By Gr) /"
j-
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
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