HomeMy WebLinkAboutBldg Permit 01-0377
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
'd
I. White File
2. Pink City
3. Yellow Applicant
-3'17-
(Please type or print and sijUl at bottom)
ADDRESS
?/;)' Cf .s PRII\16- "k. R IJ
ZONING (office use)
R ISD
LEGAL DESCRIPTION (office use only)
S -9 . J ~ 1/ _ A .-
LOT BLOCK 1~ ADDITION S ~&-LtLLe...-~~
OWNER / /YJ 0
(Name) ~fim l.:s c / / /1(::' 'k "- .:- Y (Phone)
l/ /
(Address)
BUILDER
(Name) SAmc_
(Contact Name)
(Address)
TYPE OF WORK
o Misc.
PID dS"" - ! 3 ~ -D 3"H.'
95"0) ... o/'~O '-~.....7 0 c;
(Phone)
(Phone)
. ~A n,~
o New Construction
ODeck
OPorch
~
~Roofing
ORe-Siding
DLower Level Finish
o Fireplace
DAddition
DAlteration
PROJECTCOST/VALUE (exc1udingland) $
I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct. I al
authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws and
submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore~ereby agr, that the
enter upon th7roperty to perform neede~ctions. ~
X /"YAmicfC /?;A~
, ./ Signature'/
,/
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
-'
I Park Suppa
I SAC
I Water Mete Size
I Pressure Reducer
I Sewer IW ater Conne
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
$
$
# $
# $
$
$
$1~ ,00
ReceiptNo~45 -~ i 1
By a..c....
U
$ -;L/,15
$
$ J"~5
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
I Paid
I Date
'Ito ,00
Lf....30- 0 I
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