HomeMy WebLinkAboutBldg Permit 01-1131
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS :; 4 Y L-\
1. White File
2. Pink City
3. Yellow Applicant
~\'OQy- ~)
?OND "'\~.L.
LEGAL DESCRIPTION (office use only)
LOT;?l..BLOCK ~ADDmON t?UAJp~ Ri~
OWNER
(Name) ~'l \&-t4 ~6~
(Address)
.~. C1 U L--
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U~"')D~O
~ \OO;~ fO'~O
Date Rec' d
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PID ~5"" - aJ;r'" tXJ 5- U
BUILDER
(Name) cA~~~ \ (./
(Contact Name) /A/I L/l/ J .p('{\.
(Address) /--WYtTD I J..-~I-'
(Phone) / -- idC/D, ~i)Cj ---o}AD .
(Phone) 'I
fJ 1/t.A{SI//(~
TYPE OF WORK
<\Z-e::>c~.5
~V~
--'"
...~
/7.
OPorch ~OOfing ORe-Siding
ce OAddition OAlteration OUtility Connection
ST/VALUE (excluding land) $ j -& i -z...,./ . ?-::7
--- _1_
CLOSE FILE
10/28/03 MP
. o Misc.
I hereby certify that I have ml~U"'" ~..___. ; to the best of my knowledge true and correct. I also certify that I am the owner or
authorized agent for the a~e- ntioned roperty and that au Wu.~__. will conform to all existing state and local laws and will proceed in accordance with
submitted Pla~n.7taw e the b . .' of~icial can revoke this permit for' t cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the p p t e nee msp ons.
X .f Ie;--ID~{)'
v v V Si~ture Contractor's License No. Date
Permit Valuation
Permit Fee
I Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
7L1.75""
,
I" Q... ~
Park Support Fee
SAC
I Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
I Paid
I Date
7fL .()U
!tJ .-/C-o I
Building Official
Date
# . $
# $
$
$
# $
# $
$
$
$ 7~ .00
Receipt No. U(JlnX d
By Icrf/
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