HomeMy WebLinkAboutBldg Permit 01-0727
Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3. Yellow Applicant
(Please type or print and sign at bv..v...)
ADDRESS
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LEGAL DESCRL.t'uON (office use only)
LOT
BLOCK
ADDITION
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(Address) I "S(~ IS r: dl p"; n +t n ~OJ ~.1;.
BUILDER f\ I '" 0 \
(Name) UN\tIM(\v\ I~~-\ I~
(Contact Name) . \\ S~~l\~1 \j .
(Address) ~b ~J:J.,e, ~. ~n rt\L~QttlJ.. \ MIJ
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ZONING (office use)
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PID -;;)5'-110)- !)oJ.--1
(Phone) c.ilil- ~
(Phone) h\l-~
(Phone)
o Fireplace OAddition OAlteration
JJECTCOST/VALUE (exdudingland) $ 5~h"'S.(JO
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I hereby cer. In 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
enter upon the property to perform needed inspections.
X .~~ hA,^^oU
J 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
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TYPE 01
ODeck
OPorch
~e-Roofing
o Misc.
CLOSE FILE
10/28/03 MP
mi1.3/ b~
Contractor's License No.
$ 71/- 7~
$
$
$
$
$
$
$
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
7t, .00
7-/7-0 I
I,. ;)r--
This Application Becomes Your Building Permit When Approved
I Paid
I Date
Building Official
Date
#
#
#
#
ORe-Siding
OUtility Connection
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$
$
$
$
$
$
$
$
$ 7" oJ
ReceiPt No. L/O / d K./
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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