HomeMy WebLinkAboutBuilding 06-0953
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
n at bottom)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
Date Rec' d
White
Pink
1 '{ellow
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--
File
City
Applicant
'"
ZONING (office lIse)
PID
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,
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OWNER
(Name)
. t'
(Address)
(Phone)
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BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
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TYPE OF WORK D New Construction DDeck Dporch ORe-Roofing
DAddition DAlteration DUtility Connection
CODE: OLR.C. OLB.C.
Type of Constnlction:
Occupancy Group: A B
Division:
IV
I
3
V
M
4
II
F
I
III
H
2
I
E
DLower Level Finish
D Fireplace
0Re-Siding
.....
D Mise.
A
R
5
B
S
U
$
PROJECT COST IV ALUE
(excluding land)
I hereby cCltity that I have hlIlIlshed mformatlOn on this apphcatlOn which IS to the best of my knowledge trlle and correct. I also certify that I am the owner \II authOrIzed agent tor the
ahllvc-mcntlOllcd property and that all Clmstruction will conform to all existmg statL' and local laws and will proceed in accordance with submitted plans, 1 am aware that the buildmg
()ftiClal can revoke thl.s permit for Just cause Furthermore, I hereby agree that the CIty offICial Of a deSignee may enter upon the prnpelty to perform needed mspectHlns
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.,.1,.'1. /~i!/"'l-;.(
./Signature
".,i.~-]l,(;:, ./
/
Permit Valuation .-
/
Permit Fee $ ,
- .,
Plan Check Fee $ .- "
State Surcharge $
I Penalty $
i Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
$
Gas Fireplace Permit Fee
This Application Becomes Your Building Permit When Approved
l)at~
lluildlllg Uflicial
..;; ( ~.' .,., () .(;
Contractor's License No.
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit i $
Other $
TOTAL DUE $ .
Paid
Date
Receipt No.
By
,
;'
ThlS IS to certify that the request m the abuve applicatlon and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested ThiS document
\'./hen signed by the City Planner Clmstltutcs a temporary Certificate of ZOl1lng compliance and allows cunstruction to commence Befnfe occupancy, it Certificate ()f Occupancy must be
Issued
Planning Director
Special Conditions, if any
Date
2-1 hOllr notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372