HomeMy WebLinkAboutBuilding 06-0861
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
'1 ZZ~ b
(Please type or print and sign at bottom)
ADDRESS
t/;?7S" Ct:J~J/77~ !,d
LEGAL DESCRIPTION (office use only)
,
BLOCK
ADDITION
OWNER
(Name)
Su j<J-
'~7-5
Lc~
C t7~....c....J-/I"'1~ ,.J
(Address)
White
Pink
Yellow
File
City
Applicant
I PERMIT NO. 0'.0 8fo/
ZONING (office use)
PID ZS. Z/!)f'. 058
~
(Phone) 9(;2 -y~
.->5'J72
$'/1 7
,
q{~- 9J{'.- 7~.;zC:
.
BUILDER
(Company Name)
(Contact Name) IJ /AA~
(Address)
SELA RO~I=ING & RE~10D
~_4100 EXCELSIOR B~~:~(j. '!\Ie
ST, LOUIS PARK MN l'\"'11'
in ' ..,0'. ..
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration OUtility Connection 0 Misc.
I hereby eertily that I have hlrmshed mformation on this application which is to the best of my knowledge true and correct. I also certIfy that I am the owner or authonzed agent for the
above-mentlOned 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 buildmg
official can revoke tlus permit for Just cause Furthermo I hereby agree that the cay official or a designee may enter upon the property to perform needed mspecllons
, j()lS/;/ 9/;20/6't"
Contractor's License No. / Date
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
III IV V A
HIM R
2 3 4 5
x
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
BuildllH! Otlicial
Dale
JelI2qS'--
,
B
S U
PROJECT COST IV ALUE $
(excluding land)
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 1'. ()()
Paid
Date
l~u(,
IReC~NO S~z.3
'1.
ThIS IS to certify that the request 10 the above applicatlOn and accompanying documents is 10 accordance with the City Zoning Ordinance and may proceed as requested ThIS document
when signed by the City Planner constItutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a CertIficate of Occupancy must be
isslIed
Planning Director
Special Conditions, if any
Dale
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372