HomeMy WebLinkAboutBldg Permit 01-1156
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CITY OF PRIOR LAKE BUILDING PERMIT, 7 r;..t ~
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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I. White File
2. Pink City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS j(/ /I ...
~St ()~ I~~se
LEGAL DESCRIPTION (office use only)
LOT It.( BLOCK ( ADDmON ~ae, fl)lflp
OWNE&--'" -::- tJL .. ." /1/7_ .. ~
(Name)~~(~
(AddreSs)~E tis ~ILE
~~~;:~LJ I( l3It,0 Gre;e/:d~s
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,. .
(Contact Name)
(Address)
TYPE OF WOR'
ODeck
OPorch
o Misc.
CLOSE FILE
10/28/03 Mp
,lace
OAddition
:OST/VALUE (excluding land) $
Date Rec' d
"I
.~.
."'
I PERMIT NO. 0/1" I) 5" ~
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PID ~5-3"-3S- tJ /Lf-Q
(Phon{2?:J) t)cj 7 ~%W2I
.
~-ROOfing
OAlteration
ORe-Siding
OUtility Connection
I hereby certify that I have lUuu__. h 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 propt:HJ _. on will conform to all existing state and local laws and will proceed in accordance with
ial can revoke uu. y.:rmit for just cause. Furthermore, I hereby agree that the city official or a designee may
ns. ~&,q /l>/;t>~1
. Contra~or's License No. . . Date
(Phon{.~/t~/~a-~
(Phone)
&5' ~CN ~E /h .-55".,.~tt
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I Permit Valuation
Permit Fee
Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
I Park Support Fee
SAC
$ '7'1... 7~
$
$ /rJ..~
$
$
$
$
$
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
I Water Tower Fee
Builder's Deposit
Other
I TOTAL DUE
I paid})? (p ,v.S--
, Date /O~ Id.-O f
This Application Becomes Your Building Permit When Approved
Building Official
Date
# '$
# $
$
$
# $
# $
$
$
$ 1ft, ,OJ
Receipt No. t1 U If 06
By ft0
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