HomeMy WebLinkAboutBldg Permit 01-0976
(Please type or print and sign at bottom)
ADDRESS
594-cJ
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3. Yellow Applicant
Me.olNHL 121 Oc;,,6 77G.-"
LEGAL DESCRIPTION (office use only)
LOT I~LOCK I ADDITION a~~
OWNER
(Name)
(Address)
BUILDER
(N ame)
(Contact Name)
(Address)
t;A-rZ5 ~F-/~?
-Bt"(..'L c 6"f-ns
'1(.,. it'o
TYPE OF WO.,...TT
>,"~/"'t!'l
C-
Ill.
""'...T ____ ,..,___.0.....-..-...:...._
o Misc.
CLOSE FILE
10/28/03 MP
Date Rec' d
-0 I
ZONING (office use)
PtJO
,J?dlf ) <: -4rn Z-5 - 2..99-1)/7 - 0
(Phone)
(Phone) (7(;37
(Phone)
11"1J4--0V Pt
14t,,,,
~. ~ U - CJO V 3
2"
SS-t1'VL
ORe-Siding
OUtility Connection
I hereby certify th ch is to the best of my knowledge true and correct. I also certify that I am the owner or
authorized agent fl._ ___ _n. _ __nm_. .:ion 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
exnter upo~~rty)l-P). -.. ,i:vv"", needed inspections.
c~L~ I3c--'-'))'] 07j~,,-A:x>)
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
$
$
$
$
$
$
$
$
2-, S; 0 0 . 0 0
74. 7 t;;""
/. 2-r
"'" Aw7i;;:;;r~"" PrnnitWhon Appro..'
Building Official Date
nT)eck
~e-Roofing
OAlteration
# $
# $
$
$
# $
# $
$
$
$"7~. 00
,
. --\
~~c,~~
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
OPorch
replace
OAddition
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
:COST/VALUE (excluding land) $
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
I Paid
I Date
'7~. 0 0
'7- 7-01