HomeMy WebLinkAboutBldg Permit 01-1414
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPDRARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
(Please type or print and sign at bottom)
ADDRESS
I. White File
2. Pink City
3 . Yellow Applicant
PERMIT NO. t)/- 14 J4
ZONING (office use)
5 -, 'j ~5 ~:. ("' O.,e]., ~ f"lc:::l (" ~
5 -1-,
1',,fr-
put)
LEGAL DESCRIPTION (office use only)
LOT-J BLOCK ~ ADDITION CA1- D'./lIA!,.
(2<.) 6& r;;
PID L')-2qq~~-S-o
OWNER
(Name)
1"~1
~~~
~-t.
(phone)
~- ~ .::-')....
(Address) .51, S c......Q.or;4.T"\cd~'2>
t--Jt::
BUILDER JL
(Name) ~~ ~~~~/~~ 1r ~'1r'1
(Contact Name) ~~~~-\-
(Address) f,..,.O. fj;a.d"~~~ 1)1" ~.J~ \'"'ON
(Phone) G\ s~. 4....,...qr.:...C\<"ic
(Phone) -s.-a,~
5S-?:i~
o Misc.
CLOSE FILE
10/28/03 MP
OPorch
OAddition
~e-ROOfing
OAlteration
ORe-Siding
TYPE OF WORK
OUtility Connection
&.LUE (excluding land) $ 1 <l; S - ~
I hereby certify that I have funlJ"m.... ~_____ ~ best of my knowledge true and correct. I also certify that I am the owner or
authorized agent for the above-mentioned property and that all constl'UcuUll ..... ~\mform to all existing state and local laws and will proceed in accordance with
submitted plans. I am aware~at the uilding official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the p~op~ to perfo eded inspections. I
X ~. l.94o",,> \-q ~ 0
.. Signature Contractor's License No. Date
Permit Valuation 2--<::;00.- Park Support Fee # $
Permit Fee $ 1+ .7C; SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
State Surcharge $ '.L-~ I Pressure Reducer $
Penalty $ I Sewer/Water Connection Fee # $
Plumbing Permit Fee $ I Water Tower Fee # $
Mechanical Permit Fee $ I Builder's Deposit $
Sewer & Water Permit Fee $ Other $
I Gas Fireplace Permit Fee $ TOTAL DUE $ 7"_-
I J .
I Paid 1~-7 .. ReceiPt~
I Date ., . 8 0' By
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 b..}'v...ry Certificate of Zoning compliance and allows consttuction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
)1
U
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