HomeMy WebLinkAboutBuilding Permit 03-0848
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICAtE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
(,. z&. 0:3
(Phone)
(Phone)
~ j ~ d t.J A-/'/ 52::> V {p ,
1. White File
2. Pink City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
39/5' ~5~~f3~ ~/Oo/6 ,e.o
LEGAL DESCRIPTION (office use only)
LOT
ADDITION t,OJV/MON A~
BLOCK
OWNER
(Name)
(Phone)
(Address)
BillLDER
(Name) G5/V~
(Contact Name)
(Address) 14-7~ 5.
~/lN
,
e-o tl ~ ,c:;- 77U...-. I
TYPE OF WORK
ODed
o Porch
o Addition
o New Construction
OLower Level Finish
}C'MiSC. Z'/ ner~
o Fireplace
PROJECT COST IV ALUE (excluding land) $
ZONING (office use)
If?-I
PIDzE-3t1S - tJS2--0
ORe-Roofing
ORe-Siding
o Alteration
1
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
~ter upon the property to perform needed inspections.
I
x
Signature
Contractor's License No.
Permit Valuation
Park Support Fee
SAC
P.:..uuit Fee
$
$
$
$
$
$
$
$
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Water Meter Size 5/8"; 1";
Pressure Reducer
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water P.:..uuit Fee
Gas Fireplace P.:..uuit Fee
This Application Becomes Your Building Permit When Approved
STJO. C)()
7-j - 03
Paid
Date
Building Official
Date
Date
# $
# $
2'1 $
$
# $
# $
$
$
~
II
Rece;:;Jo.
By ~
U
500. (J ()
60().00
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