HomeMy WebLinkAboutBldg Permit 01-0853
(Please type or print and sign at bottom)
. ADDRESS
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White File
2. Pink City
1 Yellow Applicant
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LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
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OWNER
(Name)
Lo('eil
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(Address)
BUILDER
(Name)
(Contact Name)
(Address)
S'1ocifo 11
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!1tJo!711 OJ
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(Phone)
(Phone)
(Phone)
TYPE OF WORK
CLOSE FILE
10/28/03 MP
OPorch
QIt.e. Roofing
DAlteration
o Misc.
DAddition
.'/VALUE (exc1udingland) $
Date Rec' d
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PERMIT NO. oA853
-CNfNG (office use)
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ORe.Siding
DUtility 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 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 ~ope~o perform needej )p~pectio_ns. . <7/ L:i J I
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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
$
$
$
$
$
$
$
$
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
Builder's Deposit
Other
I TOTAL DUE
This Application Becomes Your Building Permit When Approved
I Paid
I Date
'l(~ .c/V
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Building Official
Date
# $
# $
$
$
# $
# $
$
$
$
(JA
Recei q
By
This is to certity 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