HomeMy WebLinkAboutBldg Permit 01-1053
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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LEGAL DESCRIPTION (office use only) /J -.. .
LOT I BLOCK 'I ADDITION ~~ () ~l.sf-
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(Please type or print and siJtll at bottom)
ADDRESS
1~733
OWNER
(Name)
(Address)
BUILDER
(Name) ~~'l j
(Contact Name)
(Address) 30 SlJ (.;)
TYPE OF WORK
o Misc.
x
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
&06 ~/;, f
doa
o New Construction
OLower Level Finish
Date Rec' d
1. White File
2. Pink City
3 . Yellow Applicant
NING (office use)
R./sO
PIDd)'- /L/?- o5q-C>
(Phone)
'f~o- 3/(}-~
Sf-
(Phone) L/9;J. '3f~ cJ
(Phone)
']OLd .IJIV /11/1/
ODeck
o Fireplace
OPorch
~-Roofing
OAlteration
ORe-Siding
OUtility Connection
PROJECTCOST/VALUE (exc1udingland) $
OAddition
$
$
$
$
$
$
$
$
7'1- 74)'
I hereby certify that I have furnished information 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 upon the property to perform needed inspections.
-YYlL/OJ ~i.4/.:1/
Signature
I. oL ~
,
This Application Becomes Your Building Permit When Approved
Building Official
Date
;J 11/;;;31 '7 S
Contractor's License No.
Date
I Park Support Fe.
I SAC
I Wat
I Pres
I Sewer /
Water Tower Fee
Builder's Deposit
I Other
I TOTAL DUE
I Paid '1br CJO
I Date 4' -;:; t::'-n ,
I ·
-;~ -00
Receipt No. lit) ~ ILl
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
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245