HomeMy WebLinkAboutBuilding 06-1035
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
.& Ct.PVJ
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
J;Je
1ft2- .r+" ~r()
(Address)
5E-
Date Rec' d
I White
Pink
Yellow
I PERMIT NO. (}0 - 10::3 $'
File
City
Applicant
ZONING (office use)
PID
5- /R'1- ()g
o
(Phone)
BUILDER
(Company Name)
(Contact Name)
(Address) 3 ~5- c
~~ ~dW-
, r~~~
?oV d.:::b ~
(Phone)
(Phone)
Lf ~';;-.?J 7 3 7
//
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TYPE OF WORK 0 New Construction ODeck o Porch e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration o Utility ConnectIOn
CODE: DI.R.C. DI.B.c.
Type of Constmction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
o Misc.
A
R
5
B
S
PROJECT COST IV ALUE
(excluding land)
$
U
I hereby certify that I have hlrnishcd mformation 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
..lb()ve~mentlOned property and that all construction will conform to all eXIstmg state and local laws and will proceed in accordance with submItted plans_ 1 am aware that the buildmg
offiCial can revoke tillS permIt for Just cause ,J:jrthermorc, I hereby agree that the City official or a deSignee may enter upon the propel1y to pert()rm needed mspectHms
X l~ rC24/ dOI.?o'itf36 /1-/6 '-c~
Signature Contractor's License No. Date
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 $
This Application Becomes Your Building Permit When Approved
Buildl1H! Umclal
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit $
Other $IJI->:-
TOTAL DUE $
i)~~ '7'~:
i ~~ceiPt Nor~~
ThiS IS to certify that the request in the above applicatIon and accompanYing documents is in accordance with the City Zoning Ordinance and may proceed as requested TillS document
when signed by the City Planner Cllnstltutes a temporary Certificate of Zomng compliance and allows construc110n to commence. Bcfore occupancy, a Certlticate of Occupancy must be
I issued
Planning Director
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions. if any