HomeMy WebLinkAboutBldg Permit 01-0713
Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bv.~m)
ADDRESS
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I. White File
2. Pink City
3. Yellow Applicant
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LEGAL QPSCRI~TION (office use only)
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LOT) Br!OCK ADDITION
OWNER
(Name) _
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I
(Address)
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ONING(officeu~)
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(Phone) 'is-do - .ij~7 .,ft '7/
BUILDER
(Name) --tJ,'::;.&7iJt;t rfYvV'IJM'J..
(Contact Name) ~oN f
(Address) Lit.[) InJlJ kt/lW1 4ve sc- I rYll'/S{ #JYJ
TYPE OF WORK
(Phone) u/,;2 - 3?/ - J ,S-S S-
(Phone) 0/.:1 -,I'i'/rO?3 L/
-S--s- "7Ji'('" ,
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o Porch
~e-Roofing
OAlteration
ice
OAddition
o Misc.
CLOSE FILE
10/28/03 MP
1ST /V ALUE (excluding land) $
ORe-Siding
OUtility Connection
I hereby certify that I I ; to the best of my knowledge true and correct. I also certify that I am the owner or
authorized agent for th'n~_ _ rnr---J ___ ____ ___ __.._u_~_.. 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
;teruPt~to:;&;;;;#s. trd/7 7/1/'/01
Signature Contractor's License No. / "Date
I Permit Valuation
Permit Fee
Plan Check Fee
I State Surcharge
I Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
,4,'15
,
I Park Support Fee
I SAC
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
I TOTAL DUE
Paid IJ", .00
Date -1- J~ - n ~
1/;)5
This Application Becomes Your Building Permit When Approved
Building Official
Date
'$
$
$
$
$
$
$
$
$ 7~ .00
I Receipt No. l/ 0 I ()-- 5
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#
#
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I 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