HomeMy WebLinkAboutBuilding 06-1002
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/1- (,,0(,
I White
Pink
Yellow
File
City
Applicant
I PERMIT NO.
&. /60'2-1
(Please
ADDRESS
ZONING (office use)
+192-
~A/r/I
ur~6
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2- r. 2- 8tP. 6 r I. tJ
OWNER
(Name)
(Phone)
(Address)
~t...
(Phone) <j~~ 4:J' V $3(;;7
(Phone)
TYPE OF WORK 0 New Construction
OAddition OAlteration
ORe-Siding OLower Level Finish 0 Fireplace
CODE: OI.R.C. OLB.C.
Type of Construction:
Occupancy Group: A B
Division:
o Misc
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby certify that I have hlfmshed mformation on this applicatIOn which IS to the best of my knowledge true and cnrrect. I also certify that I am the owner or authOrized agent for the
Jbove-mentloned property and th all constructIOn will conform to all eXlstmg state Jnd local laws and Will proceed in accordance with submllted plans I am aware that the buildmg
official can revoke tlm perm fo 1St cause Furthermore, I hereby agree that the City official or a deSignee may enter upon the propelty to perf()rm needed mspectHlns
/IIJ../o~
Date
x
;oY6077Z
Signature
Contractor's License No.
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
Park Support Fee
#
#
$
$
$
$
$
$
$
$
$
dO
SAC
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
This Application Becomes Your Building Permit When Approved
.CIV
I. (,.()~
TOTAL DUE
1~lllldl11g Ofliclal
Date
ThiS IS to cerli!y that the request m the abuve JpphCJtllln and accompanymg documents IS m accordance with the City Zoning Ordinance and may proceed as requested ThIS document
when signed by the City Planner (nl1stltutcs a temporary Certificate of Zonmg compliance and allows construction to commence Before occupancy, a Certlfi.cate of Occupancy must be
isslled
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) "47-9850, fax (952) ..47-..2..5
4646 Dakota Street Prior Lake, MN 55372