HomeMy WebLinkAboutFence Permit 03-05
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE a
AND UTILITY CONNECTION PERMIT Lt7'
1. White File I PERMIT NO I
2. Pi.k Ci~ . ".-r},. _,..,.~
J. Yellow Applicant U:..J u..,......'""::>
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Date Rec' d
(Please type or print and siKn at bottom)
I ADDRESS
~ I Y'lf/3 DaIlE C-+ - N t
ZONING (office use)
R-I
LEGAL DESCRIPTION (office use only)
LOT I (paLOCK I
ADDITION K.nlSJ-b
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OWNER
(Name)
(Address)
Scott ~ ~cz.A ~SAtJO"A
1~~43 O()~6(.tJc, ~M...LA-~
(Phone)
q~J.. . Lf:(fl, . ~I~"
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
ODeck
o Fireplace
OPorch
ORe-Roofing
ORe-Siding
DLower Level Finish
OAddition
OAlteration
OUtility Connection
MMisc. FBNCC
PROJECT COST IV ALUE (excluding land) $
I hereby certify that I have furnisbed 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
;terup~t~ctions
Signature Contractor's License No. Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
City SAC and WAC
Water Tower Fee
Gas Fireplace
$
$
$
$
$
$
$
$
Park Support Fee
SAC
#
#
$
This
.cation Becomes Your Building Permit When Approved
Water Meter Size 5/8"; 1";
Pressure Reducer
P'
ate
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
::;=e ~ti~~mfia~ ;;~~;e and anom conmuroon '0 commence. Bd= occupan~. a Cmfia'e ofOccupan~ must be
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
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