HomeMy WebLinkAboutBldg Permit 01-0601
(Please type or print and siWl at bottom)
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White File
2. Pink City
3. Ye\low Applicant
-?.5::J _/ - c:::;;,~O~ ;5' -r: 6. E
LOT
BLOCK
LEGAL DESCRlyuON (office use only)
ADDITION
Date Rec' d
PERMIT NO'UI-{) "0 /
P~("_"K)
PID;;2S"-OO 5-0/1-0
OWNER
(Name) fl./tp/tO L ~~ELb/.Z)v (Phone) ZS"Z-..".,.7-e"l'ZS-
(Address) -43.::r7- Ce>.LO~PO ::5r <:~E: P~OAL ~E ~>./.
, -,
BUILDER _ \
(Name) He>A1,.ttt:t!:>4dA/~ &,&Je,/&J.
(Contact Name)
(Address)
TYPE OF WORK
(Phone) ~7 - B9.z::r
(Phone)
CLOSE FILE
10/28/03 MP
OPorch )ii!Re-Roofing ORe-Siding
~ OAddition OAlteration OUtility Connection
~/VALUE (excluding land) $ 48CJt:)_ 4!:>t:)
o Misc.
,
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
~terupon e~ropeZ((rfZZ:~ns. J/k-~/
Signature Contractor's License No. ' , Date
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
;}.5' CJ() ,--
$ 7Lt 75'
$ .
$ / · J.S-
$
$
$
$
$
Park Support Fee
SAC
Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
Other
TOTAL DUE
; p1
'J(7 (n
(l- f ---0 I
This Application Becomes Your Building Permit When Approved
I Paid
I Date
Building Official
Date
#
#
$
$
$
$
$
$
$
$
$ 'l~ ~
#
#
Receipt No. 1...-107 <;?'lS
By ~
. 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
16200 Eagle Creek Avenue Prior Lake, MN 55372