HomeMy WebLinkAboutBldg Permit 02-0576
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPQRARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 5- d.. a-:- :'
(Please type or print and silm at bu.LV~)
ADDRESS
I. White File
2, Pink City
3, Ye\low Applicant
I PERMIT NOLJ~ - ~ ')7 &, I
ZRis13U~)
1ft,57lf
P 1Mb Cvre/ 5E
LEGAL DESCRIPTION (office use only)
LO~ BLOCK 1./ ADDITION
,
~10> p~'
PIQ9S-096'" C;OJ.. -;()
/
(Phone~)~ 0;.17- b g~r
"-
&V::~~1J 0
(Address) / ~ 23 '/ <J; o...rL ~ ~t."
BUILDER ,-.J I --r- . t) I
(Name)-=:: ~~ \~...,., (Phone) (,s1-~~ -b'" 'Q).()
(ContactName) -'" ... -~ · . (Phone)
(Address) .J~75J IlAClLkJ}. ~ l.R&.()~' tfY)f)
TYPE OF WORK
o New Constnlmon
5,"3iDC,
I
nT)eck
OPorch
OAddition
~e-ROOfing
OAlteration
OUtility Connection
ORe-Siding
ireplace
CLOSE FILE rCOSTIVALUE (excluding land) $
th: 10/28/03 MP ch is to the best of my knowledge true and correct. I also certifY that I am the owner or
ent f .ion will conform to all existing state and local laws and will proceed in accordance with
IS. I am" .ware...' "" uJI""'g olIi<W Om _ke ... p<nni' "" ;..t """'. ."""""""',/-..... "", ... city ;mow "'1-, may
.pr~:t erformne dinspections. tc ~O I~(~ 43 a-r~ a;)-
Ign ~ J Contractor's License No. . Date
------
o Misc.
I permV 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
;;25tJO, -
$ '14~ 75'
$
$ I 't7t~
$
$
$
$
$
This Application Becomes Your Building Permit When Ar r- _ " J:d
Building Official
Date
--'
I Park Support Fee # $
I SAC # $
I WaterMeter SizeS/8"; I"; $
I Pressure Reducer $
Sewer/Water Connection Fee # $
WarerTowerFee # $
I Builder's Deposit $
lather $
I TOTALDUE $ 1(, - ~
. ~ ()~) . _. - ...
Paid ::lfF7lP I' ReceiPt Nckf 1;fI ([ 0"-
Date 5'- 8-~CJd-""'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 t.:......~...ry 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