HomeMy WebLinkAboutBldg Permit 01-1052
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
'1. z.+~tJ /
~. ~i~~e ~::y I PERMIT NO. 01/- '()F('?
3. Yellow Applicant I , I 1/ ~
(Please type or print and sign. at bottom)
ADDRESS
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ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT "BLOCK 4ADDITION (!A~/NR'- et0G6~771 PID ~-a7?-034--0
OWNER
(Name ) (Phone)
(Address)
BUILDER _
(Name) e::: X t e... .., 0- e i-/ luo,-(I e M. e I'-" t> ,T /</C'
(Contact Name) ~ -co....,- I
.-/
- ~
(Address) 1){;() [,v- 610Pkr . f P"~e-~a-, Itff;rf{ t3/t/d""t ~
TYPE OF WORK
o Misc.
(Phone)
(Phone)
Cj5~- ~ol-/5{J 3
('1 J..' '/ 01-f J I
CLOSEFl~E
10/28/03 MI,>
o Porch
ORe-Roofing
OAlteration
<,
)(Re-Siding
OUtility Connection
I hereby certifY that I have ful . 'c,:~","Jll 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-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 u~o the property ~rf~eded in~pectiOn..~
X 7'- ~~ q-;;J'f-e;l
, SignP're V Contractor's License No, Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
OAddition
\.LUE (excluding land) S
z"s 60.00
$ 7c/. 7~
$
$
$
$
$
$
$
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
#
#
#
#
$
$
$
$
$
$
$
$
$ 7&.00
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. )...\
I TOTAL DUE
I Paid
I Date
7f4. crv
er.z,~..() ,
Date
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245