HomeMy WebLinkAboutBldg Permit 01-0881
(Please type or print and sign at bottom)
ADDRESS
35j-S
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White File
2. Pink City
3. Yellow Applicant
PERMIT NO.
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LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
PID ZS ~/fl - 02/-1)
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BUILDER ~ () H A
(Name) . / .,/l,..I _ __:X.;-)~,- 0 ~
(Contact Name) ........\ E FF
(Address) LI W L:" ~A /J I /1
7 / J //~""- rlAJ-f .
OWNER
(Name)
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3 35';;-.../
(Address)
TYPE OF WORK
o Misc.
Date Rec' d
.i J/U_
(Phone) 9?z- L/q7- 6B32-
(--i') ~
(Phone) 6/Z- 331-/SSr
(Phone) ..lL2. - ~ B _ <}: ~ 9 ')H
~~6~
.
::JPorch ~e-ROOfing ORe-Siding
:JAddition OAlteration OUtility Connection
IE (excluding land) $ S~. <Q.
n NpUT ,-,....---- _."
CLOSE FILE
10/28/03 MP
I hereby certifY that I have fumis: t of my knowledge true and correct. I also certifY that I am the owner or '
authorized agent for the above-m, _ _ ..___ _,", .." ...ul1~aucnon will conform to all existing state and local laws and will proceed in accordance with
'''''Dllt1<d ~ .my :;:::tat "" Wiling offio.r = =0,", dU, """", fot ju" a~. Furthetrn=. I ""'by 'gre< thot "" city olliciot Ot . _ =y
;ter~e :7Jrm~ 86/7 R/i7~/
~ /1fJ. A Signature / Contractor's License No. Date
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Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
2~ ~V.tn.I
. 7<<1 .1c-
Park Support Fee
#
SAC
#
Water Meter
Size 5/8"; I";
1.2.-r
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
#
#
$
$
$
$
$
$
$
$
$ '1 (" VV
,
I Paid
I Date
7tR.vV
J/-11'o'
Rece;pOp 0 4d3(P 7
By "
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This APn%YJ~comes Your Building Permit When Approved
1JtI11~ ~./7-o (
Building Official Date
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