HomeMy WebLinkAboutBldg Permit 02-0723
(Please type or print and siRll at bottom)
ADDRESS
/4597
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Date Rec' d
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3 . Yellow Applicant
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LOT
BLOCK
LEGAL DESCRIPTION (office use only)
OWNER
(Name)
(Address)
ADDITION
BUILDER ~
(Name)
(Contact Name)' "/1-1
(Address)
~
TYPE OF WORK CLOSE FILE
10/28/03 MP
o Misc.
(Phone)
(Phone)
(Phone)
OPorch
- .
.lRe-ROOfing
DAlteration
__w~..,~. ....vST/VALUE (excluding land) $
e
OAddition
I PERMIT NO. dt-Oiz'3
ZONING (office use)
IeI-1 0
PIDZ5"- 1.3" - d'l--O
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ORe-Siding
DUtility Connection
I hereby certifY that I have furnished information on this application which 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
enter upo..n ~:.~rop~.:; AO perfi~orm needed inspections. / ~ 18',.../'1 "'\
~ f1'L,4\,J( :) D {~3/7~ ~ V'QC
X sf ture Contractor's License No. Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
Z- ~O_OO
$ 7'1. 1j
$
$ I. t.-t
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
Building Official
Date
Park Support Fee
SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
I Paid
I Date
-
'7& -(I U
~-/~-o7
# $
# $
$
$
# $
# $
$
$
$ 7~. 00
Receipt No.
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 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, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372