HomeMy WebLinkAboutBuilding Permit 03-0276
(Please type or print and sign at bottom)
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3. Yellow Applicant
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~ R"I/er- Rd
Date Rec' d
PERMIT NO. 03- d-/ ~
ZONING (office use)
;21
LEGAL DESCRIPTION (office use only)
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(Contact Name) ftllTt7..
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(Address)
TYPE OF WaR'
CLOSE FILE
10/28/03 MP
o Misc.
~'5 -- $,//-<)30(/
(Phone) ~) ( ). - .:J 2 c.J ' Lj ~ 55'
$59'/1
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(Phone)
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~e-Siding
DUtility Connection
I hereby certifY that I _ 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 in"P"rtinns.
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, .' L.,..JJlJI1. F\III'"'
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I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
;;)500- -
$ 71/" 7 ~
$ I
$ I'd~ I
$ I
$ I
$ I
$ I
$ I
This Application Becomes Your Building Permit When Approved
Building Official
Date
Ilace
OPorch
DAddition
DAlteration
s-/s-03
...~.
# $
# $
$
$
# $
# $
$
$
$ 76- 00
.- -
Receipt No. tf t{ O/-...:j
By g-
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
ORe-Roofing
DST/VALUE (excluding land) $
dO/,5J50f;
~"d' - ;w.,.,. .,.~'
I Park Support Fee
I SAC
I WaterMeter Size 5/8"; I";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
Builder's Deposit
Other
I TOTAL DUE
$7 b rd;)
-::s- /4-'3
I Paid
I Date
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