HomeMy WebLinkAboutBuilding 06-0492
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
BLOCK
OWNER
(Name) /?,In: ~ r',IJ~ 10 r<J
Lv/;C'C/rcl
(Address)
Date Rec' d
White
Pink
Yellow
I PERMIT NO.Of(; /
L/9~
File
City
Applicant
ZONING (office use)
S'0
PIDd'''' / 1'3.... O~~ 0
(Phone) 9 f..2. - ~c; - ~...? i.j
BUILDER
(Company Name) ~~ S;/-; '(;-, 'vue ~H ~ CD,,,: ".9'lS, %PJ c-~
C/. "Y'
(Contact Name) J'-LJ c'~r: ~"1
(Address)
(Phone) vS-...z. - YS--/-9900
,
(Phone) p/.;.l- ...<f{)-S'CUr
TYPE OF WORK 0 New Construction ODeck OPorch ORe,Roofing
OAddition DAlteration DUtility Connection
CODE: OLR.C. OLB.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
III
H
2
IV V
I M
3 4
o Fireplace
o Mise.
A
R
5
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby certifY that I have furnIshed mf(lrmation 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 wnstruction wIll conform to all eXlsl1ng state and local laws and will proceed in accordance with submitted plans. I am aware that the buildrng
official can re Jke thiS permIt for Just cause Furthermore, I hereby agree that the City official or a deSIgnee may enter upon the property to perform needed I spectlo s
Signature
Permit Valuation
Permit Fee $
Plan Check Fee $
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
Buildllll! Ofticial
Date
..2.0 5'i~ Lj /(
Contractor's License No.
...s
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 $ /)(, ~
_..
Paid
Date
'71;:;:6 1
- 'q'j (/
Receipt No0 /
By 6
ThIS IS to clTtifY that the request m the above applicatIon and accompanymg documents IS m accordance with the City Zoning Ordinance and may proceed as requested TillS document
when signed by the City Planner wnstltutes a temporary Certificate of Zomng complrance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
isslIed
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372