HomeMy WebLinkAboutBuilding 06-0734
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
8. /4-. o~
at bottom)
$w
1. White File I PERMIT NO A_
i ~~~w ~~~licant . 0 (;. 073 If
ZONING (office use)
P r lc(
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) ].\A\1'\L'U ~W\('.utJ
~i c~ ~+~J..t
(Address)
'1~q- W; 1/6W LAV\t- S.~l
(Phone)
q 5 .1 - ;)..;;U...- b"7 '1 ~
BUILDER
(Company Name)
- DWN2 'f'
(Phone)
s"- tf
(Contact Name)
(Phone)
(Address)
TYPE OF WORK 0 New Construction ODeck OPorch Di!Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
o Addition o Alteration OUtility Connection
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
III IV VA
HIM R
2 3 4 5
o Mise:
B
S U
dO
~Og~ ..,
PROJECT COSTfV ALUE $
(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 accordance with submitted plans. I am aware that
the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed
~P~nae &'h~ 8-3-0'=:>
Signature
Permit Valuation
Permit Fee $
Plan Check Fee $ I
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When
Approved
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 $
Other $
TOTAL DUE $ /G.tJO
I Paid
Date
1~ -
8./~.'.
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