HomeMy WebLinkAboutBldg Permit 01-1364
Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sij!;ll at bottom)
ADDRESS
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2. Pink City
3. Ye\low Applicant
LEGAL DESCRIPTION (office use only) ()
LOT (PBLOCK 3> ADDITION CAP-Dl~ V '. ()cs*-
OWNER
(Name)
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(Address)
BUILDER
(Name)
(Contact Name)
(Address)
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TYPE OF W"~"~
CLOSE FILE
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. ONING (office use)
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(Phone) qJ?- #'7-~SJ-~
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(Phone)
(Phone)
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ORe-Siding
OUtility Connection
I hereby certi ___" ~pJ.',,,;..uon which is to the best of my knowledge true and correct I also certify that I am the owner or
authorized af, __ __' "'~ ..uuve-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
~ter upon the prop' .u ~~~nspections. d-o/ (p ~ l/ tJ~ 1~1 ~ /0 I
Ignature Contractor's License No. Date '
Permit Valuation
'"25C>O. -
7t. "
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 $
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Bu~al '" (Date f
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l,2.-S
ODeck
OPorch
OAddition
~e-Roofing
#
#
#
#
1$
$
$
$
$
$
$
$
$ 70...-
Receipt No. +ocr, 2-
By J2..i)~
. 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,
o Fireplace
OAlteration
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
IJECT COST /V ALUE (excluding land) $
I Park Support Fee
I SAC
I Water Meter Size 5/8"; 1";
I Pressure Reducer
I Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
I Other
I TOTAL DUE
I Paid
I Date
ICp- 'J'-
a-t t:;"" lor
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