HomeMy WebLinkAboutMeter Sale AMill
of PRI() CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCEa . ••
x
AND UTILITY CONNECTION PERMIT
1.1
4rIHAEs0.0' I. White File
2. Pink City PERMIT NO. 45- i`!--
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
e9-1 Ci '47
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER /' e // /� �-1'�f r
(Name) / - ir P i (Phone)
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ['Deck ['Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑LR.C. I.B.C.❑ Misc. 5/0 r1 /I/ IZ��Z—
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
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 2` /
SignatureG , e _ Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $ 5o 0 _O a,
State Surcharge $ Pressure Reducerl Q° �
_ ism _
Penalty $ Sewer/Water Connection Fee # $ -
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other 4
Gas Fireplace Permit Fee $ TOTAL DUE
2.../L.l ,/�6) t 0 0
44
gip 0
This plicatioaifei<_____
Your Building Permit When Approved Pas > °-
: . tir
2 , to L� •ate � , 51 /S---
/
S 1'y %
Buildmal Date " I'
/4,4 / Z. 5. l �. z. l�_s
T is r.t*it t the r1 7,.. . , o and accompanying documen. is in accordance with the City Zoning Ordinance and may proceed, ' '.quested. This docume
en i,ne. .y -e City ',n r onsti Utes a t• .. ry Certificate of Zon g complia e as (Instruction to commence Before orrupancY.a Cr I cite of Orcupi cy mu be
assn f �� I6 IN eL < / O Ub , .zi, , (/[�
Planning Director .:tois
/I Special Con cions,if any
�� d�hour notice for all inspec.ions(952)447-9850,fax(952)447-4245
7d/ DV 334,`... 4646 Dakota Str e, `