HomeMy WebLinkAboutBldg Permit 01-1161
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I,..J. U U.t' t'RlOR LAKE
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Date Rec'd
CITY O~ PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERuJlJCATE OF ZONING COMPLIANCE
AND lJ JILITY CONNECTION PERMIT
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I PERMIT NO. 0 1-// &, I I
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(Please .~c Of print and ,ilOl ar bottom)
. ADDRESS
1400B r...u+Qer~ 0-+ N,~
LEGAL DESCltLr uON (oftic:c uae only)
LO~BLOCK( ADDITION ~. iJa/)jWn.-J
OWNER k j - I i
(Name) I.....lll.(~ 4- J- ve r) e n(J;V' P
(Ad.a-c.ss) I Llo6~ . fZ V+0e Y6 0+. N.~.
BUILDER
(Nam~) fSvc\B e.-\--- ~)(.hP v\ OVo
(Contact Name) A m b-F y- (l E 0r-(~ r:-
(Address) ~ 0 I i- N l ( 0 II L 4- A V ~
TYPE OF WOR
(phone)
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(f-"U50
PID 6J5-/~/- OtJ d-O
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. (Phone) g? 2 '$ 't(-=t- - It () 1 3
(p~one) ~0 l.- <tX"+- Ilt>) 6
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CLOSE FILE
10/28/03 MP
Dporc.b
OAddition
DR.c:.RooftDg
OA)teracion
ORc.sidioJ
DUality ConDeetiOll.
I hereby certify that I ' the bc$t or my kDowledp trUe all4 ....... t alto cenify tIlat I IJTIl2Ioe 0MIeI' or
luthoriftclaSl!ar fbr ~ _ _ _._.,___ ..."......, ..,.. "".. aU gmtV1lCl1Oft WiD eoafonn fO all exisMI state and loca1llwalllCl win~". .. .: it! aa:or4aJlce with
slit/mined pliDS. I am aware that lbe bulldilll official can make this permit ror just eause. fant1ermon:, 1 hereby awee that the city ot!iciaI or I ~sipee ::my
tnler lJPOTI the p . ~ ."..: bl perform needed IDJpI!Cl1ons.
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Silll'&~
I Permil Valuation
I Pennit Fee
Plan Check Fee
Scace Surcharge
I Penally
I Plumbing Permit Pee
I Mechanical Permit Fee
I Sewer & Water Pmnit Fee
I Gas F'ueplact Permit Fee
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This AppU. ,: .. Becomet Your Buildlnl Permit WbeII Approved
ButJclln. omRa!
Dati
'/VALUE (ucludialllDd) S
{o0{~ L/
C01ltr&ctor'~ No.
I Park Support Fee
15AC
I Wafrr Meter Size SIB"; I";
I Pressure Reduc:et'
I Sewe~/Wllt.eJ' Connection Fce
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Paid .fI' / ~ ,OU
Dale / ~ --- I J) -0 I
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Date
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I Rec~ No,
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'Tblt is 10 ca1ifr lhal the ~"$I ill che aboye lppIlc&tlon and Ie.. . .,. ,..j,. .doc:ulllClllS II In amml-,," "j(l lhe Ci1)' Zollltll 0nIit_1Ild lNJ' pt0cct4 U I."", ,.l 'I1liI daoallleftf
wMlI siCMd boy rht Ciq P1anll8 collStitllW a temporary CcI1i6cm of ZoIIIIII__.....i.:lrlce ..IIS.u-. CCIIstrvctlon 10 .. ...!:c. !tfare...". lICY.' Cen:IlIaft!otOa:upucy 1DIIt\ll
iall.4.
PIlMing DII'IlClor
DR Spccill Conditlclu. if.y
14 hoar .ode. tor .11 iwspcctiOOJ (951) ....'-9t50, ,.. (951) 447-4245