HomeMy WebLinkAboutBuilding Permit 07-0852
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE. .
AND UTILITY CONNECTION PERMIT
(Pkue type or print IIIId sip at bottom)
I ADDIlESS
\ "1 \ ~ 0 11)~ h -h
A:w. S E
I LEGAL DI!SClUP110N (...."".....l
LOT BLOCK ADDmON
Date Rcc'd
97.(/7
i:!it Sa.. I PERMIT NO. 07, oesz...1
I I ZONING <-.,
PID
OWNEll
(Name)
(phone)
q )2-4lfO-- ~" ~
(Address)
) ~ b", s-hVlAs
\1\~b1vV"~~-h.k Sf
BURDER
(Company Name)
(Contact Name)
(Address) 6~tf/
(phone) I/CI'~~9..y 3M
.
(phone)
5" 8' OJ-
TYPE OF WORK DNew Construction ODedc OPorch ORe-Roofing
OAddition OAlteration OUtility Connection 0 Misc.
. CODE: OI.R.C. OI.B.C.
Type of CODStnu.tion: I
OctUpancy Gmup: A B E
Dil'ision:
u mIVVAB
F HI MRSU
I 2 3 4 5
o Fireplace
~ 1 40()
-
PROJECT COST/VALUE S
(excluding land)
I bercby certifY thai I ILtw fumishtd information 00 this lIppJicllllon which is 10 the best of my know~ lnIt and COl'I'eCl. I &Iso mtify thai I am the owner III' aulhorizcd accnt (or the
above.lIlaItJoned prapmy and that aU COIIStruction will con/bnn to aU existinc ~ and local laws and will prllCftd in ICCOrIIaalcl: with submitled pl&ns. I am awarc IlLtt the buildina
:fficiaI can rnokr this pmnil '3':;:sc. Furlhcrtl1On!. I hereby alfCC that the city;:;; *;;r ; ClUer upon the propcny to perform need; 17ioon~
Signature ContrletDr's Licznse No. Dall:
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer &; Water Permit Fee $
Gas Fireplace Permit Fee S
Tbis Application Bec:omes Your Bulldm, Permit Whca AppI'OYe.
Buildinr. Official.
DlIc
Park Support Fee
SAC
##
##
WaterMeter SizeS/S"; I";
Pressure Reducer
Sewer/Water Connection Fee ##
Water Tower Fee ##
Builder'. Deposit
Other
TOTAL DUB
nus is to cati/Y lhallhr request in tbc allow application lInd lCCOIIlPInyina doculllallS is in accanIanl:c with lhr City Zoom, Ordinantt and may proceed IS reqlll.'Sled. 'Ibis doculllalt
when sipH:d by lhr City Planner COIUtitutcs 1I temporary Cmilic&tc of Zonina Cllmpliantt and aUows CllIUttUc:tion to CllllllllClltt. BcfOR omrp&nc:y, a Ccniliatc ofOc:cupucy must be
islucd.
PWmina Diroctor
if lilY
Date S
24 hour uotlcc for alllupcctlons ("1) 447-9850, fax (951) 447-4245
16200 Bagle Creek Avenue Prior Lake, MN 55372