HomeMy WebLinkAboutBuilding 06-850
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Date Rec' L
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
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n at bottom)
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Pink
Yellow
1 PERMIT NO. (;(P. 08501
File
City
Applicant
ZONING (office use)
/C.1
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
J.y V1:{
BLOCK
OWNER
(Name)
c:, c.'-r ~ OJ
J)' 52-3
me.. ~~f\IP(
er"):>ks
til,.,,~o r It
~\'r S'~
(Address)
pmzr ()/(P. 0#. (J
N ~ I<;? r"\ (Phone) 9-52-_
z.2.~
BUILDER
(Company Name)
(Contact Name)
(Address)
~Q /-f:
(Phone)
(Phone)
TYPE OF WORK 0 New Construction OOeck OPorch ORe-Roofing }5lRe-Siding OLower Level Finish 0 Fireplace
OAdditlon o Alteratlon o Utility ConnectIOn
CODE: DI.R.C. DI.B.C. o MIsc. Z Bd.r W ""-!O~K r ",-t,,,, J.- f.,..,~-t d" , r
Type of Construction: I II III IV V A B PROJECT COST /V ALUE $ rj, 7 .;:)o;:.~
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5 (excluding land)
I hereby certify that I have furmshed mformatlon on this applicatlOn which is to the best of my knowledge true and correct I also certify that I am the owner or <luthonzed agent for the
above-mentIOned property and that all ClmstrllctlUn will co form to allexistmg state and local laws and will proceed in accordance with submitted plans I am aware that the huildmg
~lleial ca~e tillS permit t,1l' ~~ermllrc' e 'by agree that the CIty official or a deSignee may enter upon the prope11y to perform needed inspections
~ Signature Contractor's License No. Date
Permit Valuation 2~ nJ?J
.
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $ I
This Application Becomes Your Building Pennit When Approved
Buildl11g Utflclal
Date
Park Support Fee
#
#
SAC
Water Meter Size 5/8"; 1",
Pressure Reducer
Sewer/Water Connection Fee #
Water Tower Fee #
Builder's Deposit
Other
TOTAL DUE
. (It)
ThIS IS to certIfy that the request In the abuye applrcatllln and accompanYing documents IS In accordance WIth the City Zoning Ordinance and may proceed as requested TIllS ducumcnl
.....,hcn signed by the City Planner cnnstltutes a temporary Certificate of ZL1Illng compliance and allows constructIOn to commence Before occupancy, a Certificate l)f Occupancy must be
Isslled
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9R50, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372