HomeMy WebLinkAboutFence Permit 15-59 ®� PRI® CITY OF PRIOR LAKE, BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF /ZOI�IING OOMPI_,IAI CE,
�a
AND UTILITY CONNECTION 1TION PERMIT
i. White File PERMIT NO.I
2. Pink City
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSffi
O W I Z � ce use)
ONING(o
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID �Id
OWNER 1} _
(Name) f I V. (Phone)W �� l
(Address) Y�I
bk_�
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding El Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection D
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CODE: ❑I.R.C. ❑I.B.C.
Misc. �`�r �l.0/ C t
Type of Construction: I H III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
" V 1 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 allc action 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 thi ermit for just use urt rmore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
F Plan Check Fee $ Water Meter Size 5/8"; V% $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid K Receipt o
Date jBy
Building Official Date
his is to ertify that the request in the above application and accompanying documents is in accordance wit City Zoning Ordinance and may proceed as requested. This document
W si by the City Planner constitutes a temporary Certificate of Zoning compliance and allows constru tion to commence. Before occupancy,a Certificate of Occupancy must be
ISS t
Planning Director /V\ Date Special C ndif ns,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 lb I
4646 Dakota Street Prior Lake,MN 55372
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