HomeMy WebLinkAboutBldg Permit 02-0485
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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5. -/-CJd.->
AND UTILITY CONNECTION PERMIT CO
1. White File
2. Pink City
3. Vellow Applicant
(Please type or orint and sism at bottom)
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LEGAL DESCRIPTION (office use only) .
LOT1 BLOCK I ADDITION~~ f1/'dc,.f lfcA
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OWNER
(Name)
(Address) .....
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I PERMIT N~ >>--3~f'f(501-j
ZONING (office use)
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(Phone(9~J~7~?5~
BUILDER <' /.. ~ /. _ LJ/__ ~ -. /7__ _
(Name)~ ~~ ~
(Contact Name) ~ 2J;/?-~
(Address) 1~b i)~~~ ~
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TYPE OF 1
o Misc,
CLOSE FILE
10/28/03 MP
(Phon{ ~ )8?fJ-~;:;. ~..:' .
_ (Phone)
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, . . . I
~Siding
OUtility Connection
]Deck
OPorch
ORe-Roofing
I hereby certifY that I have fi1mished 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 l"~l'''''~J 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 0 ' can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
;",u~.th<m;.: t~erfol~e!d' e' . ~<t1 J7~-;y
-I-I-f!!--" % Signature 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
::J. SCJ 0 .--
$ '-" 1f{,7S"
$
$ /,,;;.S
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
Building Official
Date
] Fireplace
OAddition
DAlteration
# $
# $
$
$
# $
# $
$
$
$ 7 ~ - 00
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ReceiptNo. L/J'l0/5
Bv /I ~./ -
VO-
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
ECf COST IV ALUE (excluding land) S
I Park Support Fee
I SAC
I WaterMeter Size5/8"j I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
I Paid
I Date
/7/\
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_~-(,.,- d-
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245