HomeMy WebLinkAboutBldg Permit 01-0926
(Please type or print and si~ at bottom)
ADDRESS
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. y.now Applicant
i ~.3/5
a r~ 5sa-AXlrCJ.- .s-r
LEGAL DESCRIPTION (office use only) p
LOT (/BLOCK (ADDITION t::}.h/J~
OWNER D^ 1/ C
(Name) lA/
(Address)
ciJ/ II Rv~
f
BUILDER . -r m ,.. '^ /
(Name) ~~ 10lCLe
(Contact Name) _ J Il.-.rn i (-'"
(Address)
TYPE OF
CLOSE FILE
1 0/28/03 MP
o Misc.
ODeck
o Fireplace
(~
. _.
~ ~PID:;) rr.., I 7;- QL~ ~ J
(Phone)
u Art- f--(Phone) Lf '-!{)- L/ I /J'3
(Phone) 9 S J- - q () ')-.3 I c.,;).;
P~'
o Porch
ORe-Roofing
OAlteration
)JECT COST IV ALUE (excluding land) $
OAddition
~Ke-::;iding
OUtility Connection
I hereby cert11y Ll'd' lUdve 'w'u,ueu UUUllUdUUU uu Ll11> dJ.'J.'U"dUon 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
SUbti ed 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
;ter on i/;iJ[J::/! nr;inspections. $-;7r 0)
Sign~e 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
$
$
$
$
$
$
$
$
'7Lf~ 75'
/, ())
This Application Becomes Your Building Permit When Approved
Building Official
Date
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
1 Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
#
#
#
#
$
$
$
$
$
$
$
$
$ '1{'_00
Receipt No. L/U ~ .q q'
Bv ~
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
I Paid ~ 7f.t, ,00
I Date t6"'~I-O \
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245