HomeMy WebLinkAboutBldg Permit 02-0956
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and si2l1 at bottom)
. ADDRESS
L White File
2. Pink City
3. Yellow Applicant
Date Rec'd
I PERMITNO'C>~_9S-b
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/657"7
LEGAL DESCRIPTION (office use only) rJ .
LOT BLOCK ADDITION ~9J-
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BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
CLOSE FILE
10/28/03 MP
o Misc.
(Phone)
(Phone)
o Porch
~Roofing
OAlteration
ZONING (office use)
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ORe-Siding
OUtility Connection
I hereby certifY that I have furnished intormilUVu v.. -- .. to the best of my knowledge true and correct. I also certifY that I am the owner or
authorized agent for b e-m....fu..ed property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. that file building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the pro eeded inspections.
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I Permit Valuation
I Permit Fee
Plan Check Fee
State Surcharge
Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
:e
OAddition
iTIVALUE (excluding land) S
Contractor's License No.
I
I $
I $
1$
I $
1$
I $
1$
I $
~ 5'cX). . i I Park Support Fee
-."J r-- f' ~.-r7 '-?c-I SAC
~ 1'-' ...... I '''-1. J...J
. I WaterMeter Size 5/8"; I";
I ' ;)- S- Pressure Reducer
City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid
Date
/11 )
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Building Official
Date
#
#
#
#
%/~~
$
$
I $
I $
I $
I $
1$
I $
I $
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I ReceiPt No. lI~5iy
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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, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372