HomeMy WebLinkAboutBldg Permit 01-0842
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 SiWl at bottom)
ADDRESS
S-S- 1 0 L P--DSS~~D ~
LOT C( BLOCK
LEGAL DESCRIPTION (office use only)
-p f2-J 0 Q... \..- ~ ~
I ADDITION ~/{II/tL ~/DG6 2/VO
OWNER
(Name)
(Address)
BUILDER C- 1 "- S S\C C7 0 D ~s
(Name) VV--' r
(Contact Name) \JV I\.....-\.....' ~N'-
(Address) \'f..- ODD I t, ~ ~ f:::-
TYPE OF WORT-
o Misc.
CLOSE FILE
10/28/03 MP
I hereby certify that ]
authorized agent for tt.." auvv<;;-' <;;l1UU
submitted plans. I am aware at
;'" upon tire 70 "'" ... "
Signature
(Phone)
(Phone)
(Phone)
6 \) (2...N.'5 \J Il-\...; ~
)lace
o Porch
OAddition
ORe-Roofing
OAlteration
Date Rec'd
8 ~ ,-0 /
PUD
r
PID ~r"302.-o0r-l)
) ...- ca Dl) ~ -7 '1- o-~J, [)
ORe-Siding
OUtility Connection
is to the best of my knowledge true and correct. I also certify that I am the owner or
u prupeny ana mat all construction will conform to all existing state and local laws and will proceed in accordance with
uildin cial can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
din eons. If / 7 / -0 I
Contractor's License No. , Da~
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
2-~SDl),<fV
$ "1t.l1S
$
$ I. ~
$
$
$
$
$
ThiS~ Ali~tiJ~'fmes Your Building Permit When Approved
;zrl ~ . 7' 0 I
, tiding Official Date
OST /v ALUE (excluding land) $
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
I Builder's Deposit
lather
I TOTALDUE
~/
liR.Ou
(1"7-/)/
I Paid
I Date
# $
# $
$
$
# $
# $
$
$
$ 7'.d U
R.eCri . rp. +033 ()
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 aIlows 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