HomeMy WebLinkAboutBldg Permit 01-0841
(Please type or print and siJtll at bottom)
ADDRESS
_~100C;
PERMIT NO/o f?~ /
;/f
'/ZONING (office use)
7< J '
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2, Pink City
3, Yeltow Applicant
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LEGAL DESCRIPTION (office use only)
LOT L( BLOCK ( ADDITIONC(?/Z .tij 1 )(JorL ,~
OWNER D 'T)
(Name) , e..tl fI.-/ K /.A.- ><
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
o Misc.
d.-lVcL
Date Rec' d
PID Ol~ - t)d{) -CO~-9
(Phone) 0'" L/L//}-t:;"'70[Y
, I .
(Phone)
(Phone)
CLOSE FILE
10/28/03 MP
o Porch
OAddition
ORe-Roofing
OAlteration
~e-Siding
OUtility Connection
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 . 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
~nt~onth~;=P?ne~ ~~/
Signature'/ / Contractor's License No. / /'Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
\.LUE (excluding land) $
$
$
$
$
$
$
$
$
7'1-/~
. Park Support Fee
SAC
#
#
/ / d-5'
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
#
#
This Application Becomes Your Building Permit When Approved
I Paid
I Date
-
- / (/J ,() ( )
~ ~(p~c51
Building Official
Date
'$
$
$
$
$
$
$
$
$ 7(, ,00
Receim..NoU O'? '*"
By (A...{'./
()
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