HomeMy WebLinkAboutBldg Permit 02-1006
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3 . Yellow Applicant
Date Rec'd
to
,
PERMITNO.O~_ /{)O~
(Please type or print and si2Il at LULL"~)
ADDRESS
A.:j"'3Z..s- - E~cA..)Q7&>
LR. A/. e::
LEGAL DESCRIPTION (office use only)
LOT{P BLOCK! ADDITIONYl1.~ .j).4/~ 3.~
ZONING (office use)
R/t::;D
PIDd.5'-07f- O{y)-{)
OWNER
(Name) t ~ ~..e-.A2. tk~
(Address) /S-sZS-E~e-a.J.A-r~e r;R./VC
BUILDER
(Name)
(Contact Name)
(Address)
(Phone) ~~7 - ..500 U
~
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~
~
TYPE OF WORK
(Phone)
(Phone)
CLOSE FILE
10/28/03 MP
o Porch ~Re-ROOfing
OAddition OAl~on
/VALUE (excluding land) S ~O..o-
,
o Misc.
ORe-Siding
OUtility Connection
I hereby certifY that I have lU>UI:lI1= UlIUllIlilUun un UllS appncanon wmcn 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 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
enx ter up th roperty t rform needed in~ctio:s.
- 8/1-rID 7_
Signature I. Contractor's License No. Dati
V
I Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
~,?OD
,'-1-15'"
I Park Support Fee
I SAC
Water Meter Size 5/8"; I";
Pressure Reducer
#
#
/,;). )
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
#
#
$
$
$
$
$
$
$
$
$ '71,., ,crD
This Application Becomes Your Building Permit When Approved
Paid
Date
7".~
. f ,.. Ie, ... () r-
. Receipt N ot..l ~ '7 Lj 0
By If ./
Building Official
Date
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) 447-9g50, tax (952) 4474245
16200 Eagle Creek Avenue Prior Lake, MN 55372
-.;r
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