HomeMy WebLinkAboutBuilding Permit 07-0369
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<5'(21/07
I PERMIT NO. () 7 -03(0'71
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I, White
2 Pink
3. Yellow
File
Cily
Appliesnl
(Please type or print and sign at bottom)
rAimRESS
U l( '3 ? 7 ~>jJerJ
Date Rec'd
ZONING (ofl1cc ]
use)
4t/€.- >>, C
LOT
LEGAL DESCRIPTION (office use only)
BLOCK
ADDITION
PID
OWNER il
(Name) ~ /'-""
(Address)
~r~cAa/
(Phone)
BUILDER
(Company Name)yt1t1l.t'/\/f ~~& e.... +::-G---~
at/\/
(PhOne~z)>'C>-6 /4'/
(Contact Name) Da~
(Address) Gt7 q /
(Phone)
{,f/,-,) V e./ 5, .;:/
"
ME
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Type of Construction:
Occupancy Group:
$
Division:
A
I
E
III IV
H I
B
S U
V
M
A
R
B
1
2
3
4
5
(excluding land)
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
accordaace with submitted plans. I am aware that the building ofl1cial can revoke this permit for just cause. Furthermore, I hereby agree that the city
o Cl esignee may enter upon the property to perform needed inspections.
~ Ua..- {/ddfo-
Signature
x
Date
Permit Fee
Plan Check Fee
state Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
-
Park Support Fee
SAC
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
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Contractor's License No.
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$
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