HomeMy WebLinkAboutBldg Permit 01-0975
(Please type or print and sign at bottom)
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
SCl25
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I. White File
2. Pink City
3 . Yellow Applicant
Date Rec' d
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ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT I U BLOCK ( ADDITION
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OWNER
(Name)
(Address)
BUILDER , ,
(Name) ~A-~S Roc rrn'7
(Contact Name) &~c:.c: 6.+n s
(Address)
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TYPE OF WORK
o Misc.
CLOSE FILE
10/28/03 MP
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(Phone)
Ply ~L.- 'TI-t
(Phone)
(Phone)
JfA..N
(7<;;.;) ~.> u- ee<../5o
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ORe-Siding
OUtility Connection
I hereby certify that I have furni~. ,t 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 ~e~erform needed inspections.
X C~L~ ~C- C,'7'3 ')S~ ~I
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
Signature
$
$
$
$
$
$
$
$
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Buifding Official Date
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:JAddition
~-ROOfing
OAlteration
Date
# $
# $
$
$
# $
# $
$
$
$ "7/0. () 0
I
Receipt;~.J 4or~c."
By~
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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
JE (excluding land) $
Contractor's License No.
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
I Other
I TOTAL DUE
I Paid
I Date
'it,. (rO
, - 7- Q I
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245