HomeMy WebLinkAboutBuilding Permit 03-1352
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
IV~ I,D J
1_ White File
2. Pink City
3. Yellow Applicant
PERMIT NO. o3-/Yszl
(Please type or print and sign at bottom)
ADDRESS
~/os-
CAJt-O~D()
sr:
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2-<:; dO(P. OZZ. C
OWNER
(Name)
(Phone)
(Address)
BUILDER C ( . A t
(Name) .t--dCPw occ{ C.CI 145
(Contact Name~ <i L( 2. 2 ~U / p <5
(Address) } LJ ~c;. ~ ,;Jell 5~j-l~
(Phone) ~5',/
t/;; ~ '-Ict(~
(Phone)
rC; /V 5:5(::.,;). t./
LV
o Misc.
CLOSE FILE
10/28/03 MP
DAddition
~-ROOfing
o Alteration
ORe-Siding
TYPE OF WORK
o New Construction
nn~_1-
OPorch
OUtility Connection
'/VALUE (excluding land) $
I hereby certify that I hav the best of my knowledge true and correct I also certify that I am the owner or
authorized agent for the a ....J conform to all existing state and local laws and will proceed in accordance with
submitted plans. I am aVl _ ----"6 vUl<.:Ial can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
~ter~pon the roperty to p~ons. ~ 0 / _ c; y _ ff<( /0 //} 10 J
-- '/'" - ) ~ Sifnature ~ Contractor's License No. / b~
~ / r
I Permit Valuation 'Z. S7flJ.. w I Park Support Fee # $
I Permit Fee $ , I SAC # $
I Plan Check Fee $ I Water Meter Size 5/8"; 1"; $
I State Surcharge $ I Pressure Reducer $
I Penalty $ I City SAC and WAC # $
I Plumbing Permit Fee $ Water Tower Fee # $
I Mechanical Permit Fee $ Builder's Deposit $
I Sewer & Water Permit Fee $ I Other $
I Gas Fireplace Permit Fee $ I TOTAL DUE $ 76 .~ e-U
./'J ; _ 11 .' (,
This Application Becomes Your Building Permit When Approved I Paid /((1. (/(/ Rec~o.ff"6t ,.-
I Date JII-J OJ B{;'
Building Official
Date
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, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372