HomeMy WebLinkAboutBldg Permit 01-0961
(Please type or print and si~ at bottom)
ADDRESS
~472-
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
UJt.-()~OO
$f.
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
OWNER
(Name)
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
I. White File
2. Pink City
J. Yellow Applicant
rf~ ()~
.'
(Phone)
~u J67G. ,e-dl) R N G
/
TYPE OF WORK
DMisc.
o NeV" ~----- -,'-
OLo\1 CLOSE FILE
10/28/03 MP
(Phone)
(Phone)
~e-ROOfing
.on OAlteration
uding land) $
Date Rec' d
9-5-0{
PERMIT NO. OI-09f.R/
ZONING (office use)
~2-
PID ZS-'1()Z- O-n- 0
ORe-Siding
OUtility Connection
I hereby certify that I have furnished info mowledge true and correct. I also certify that I am the owner or
authorized agent for the above-mentioned, , _ ___ ____ __ w""_W~"vu .uu WlUUlIlllU 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 the property to pe.fvuu needed inspections.
X _~ ~_ 9/~/o/
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
?1500.00
$ 7'1. 7:;-
$
$
$
$
$
$
$
J. Z--~
This Application Becomes Your Building Permit When Approved
e/Jl!f' 'l-.r;; ,~ /
Building Official
Date
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
I Builder's Deposit
lather
I TOTAL DUE
I Paid
I Date
'"'74-.00
t:J~J~ I
#
#
#
#
$
$
$
$
$
$
$
$
$ fl,. Q'V
ReCei~~ "1053&
By I r '-'"'"
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