HomeMy WebLinkAboutBldg Permit 01-1082
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
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Date Rec' d
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LEGAL DESCRlPTION (office use only)
LOT f BLOCK" ADDITION f)/'1iLn.; M
OWNER
(Name)
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(Address)
BUILDER
(Name)
(Contact Name)
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(Phone)
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ODeck
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OAlteration
TYPE OP wnRV n "T____ '"'---.
CLOSE FILE
o Mis( 10/28/03 MP
OPorch
o Fireplace
OAddition
PROJECTCOST/VALUE (excluding land) $
ZONING (ofliceuse)
PI
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4~O-~9'/5
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ORe-Siding
OUtility Connection
I hereb) cation which is to the best of my knowledge true and correct. I also certifY that I am the owner or
authori2. u, ___ ___ ....1 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
;teruPo&..:rtytoperfo~~~ ~ 009 7~? c;- LO / - C) I
Signature - Contractbr's License No. / Date
Permit Valuation
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
$
$
$
$
$
$
$
$
t~ 70 tJ
71../,/1.)
Park Support Fee
SAC
/ ';;'5"
I Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
I Paid If)- [) /- 0/
I Date~ Iy)
This Application Becomes Your Building Permit When Approved
Building Official
Date
# $
# $
$
$
# $
# $
$
$
.
$ 'lit, 00
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Receipt No. l/Ub () {
By {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
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245