HomeMy WebLinkAboutBldg Permit 01-0911
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
1. White File
2. Pink City
3. Yellow Applicant
(Please type or print and sie;n at bottom)
ADDRESS
/lat)5' /j ~t:Jd P d.
LEGAL DESCRJ..t'TlON (office use only)
ADDITION '-//01mi.f.rd
(JJJ7-
LOT BLOCK
OWNER --- h
(Name) LJ 0 A.J
(Address)
PIDd5'-/lf/-01o-0
3155
(Phone)
L!lJ 7
R aAfit,/ UJ1/?lntJ I~' /
I -.../
if 3'15 - 7)a/(oia ~ .
BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
o Misc.
(Phone)
(Phone)
Pr10d La-~v
'11f~-/53tf
o New Construction
o Deck
OPorch
......QRt- Roofing
ORe-Siding
OUtility Connection
OLower Level Finish
o Fireplace
OAddition
OAlteration
PROJECT COST IV ALUE (excluding land) $
I hereby certify that I have furnis in rmation 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- entio d p erty and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted Pla:~: aware at u' g official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
~teruponthi Xto nee' s . s. ;W /5tf'iS b Y; ~J to. o(
, Contractor's License No. D~te'
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
7t! :75
Park Support Fee
SAC
$
$
$
$
$
$
$
$
7~OO
'10 --5 6 i
~;;). S-
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid7&, .00
Date ~ -ri- '3-01
Receipt No.
By Or j
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