HomeMy WebLinkAboutBldg Permit 01-1054
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ADDRESS
3/'-17
OWNER
(Name)
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
6.4 fi<1<. if
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3/47
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LEGAL.DES,CR)PTIP~ (office use~ tJ 1
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LOT BLOCK ADDITIO "fIJ~
(Address)
Date Rec' d
1. White File
2. Pink City
3 . Yellow Applicant
PID"';>5'-/l/I-OdC1- 0
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(Phone) L./ t/ 7 - ~
BUILDER ~.
(Name) ~~ (JJ61.~
(Contact Name)
(Address)
TYPE OF WORK
(Phone) ~-:3f~
(Phone)
DDeck
~Roofing
ORe-Siding
o New Construction
OUtility Connection
DPorch
o Fireplace
OAddition
OAlteration
o Misc.
OLower Level Finish
P~OJECTCOST/VALUE (excluding land) $
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.
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Signature
x
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
$ 7/'/~ 7J
$
$
$
$
$
$
$
dCJ (d. 3( ?S C1~ ;) S"'O L
Contractor's License NO'of: -7 ~ Date
I Park Support Fee . $
S # , $
/8"; 1"; D $
, $
# $
~'\J :
$ 7&.-
I~ dJ-
. ater Tower F~'
Builder's DiP
I Other
I TOTAL DUE
This Application Becomes Your Building Permit When Approved
I Paid
I Date
. - )
r/h,(JV J
t/- C)S-Ol
f
Receipt No.l.{ " ~ / l./
By ~/
Building Official
Date
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