HomeMy WebLinkAboutSign Permit 97-120 Temp
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White - Applicant
Yellow - City
City of Prior Lake
APPLICATION FOR SIGN PERMIT
Permit No. q ,-I J.D
DIRECTIONS; Spaces numbered 1 thru 10 must be filled in before permit is issued
(please print or type, and sign where required
1. PARCEL NO. OF PROPERTY:
61 S~ ~ 0;). - () "'-I" - I
.
(PHONE)
~
(PHONE)
(PHONE)
6. SIGN DIMENSIONS
(square feet)
~
(Width)
91
(Depth)
10. EStim~ Value of Sign
11. Completion Z~
IF THEY ARE INCOMPLETE
I hereby certify that I have furnished i rmation on this application which is, to the best of my knowledge, tnte and correct. I also certify that I am the owner
or authorized agent for the above-mentioned property, and that all constntction will conform to all existing state and local laws and will proceed in accordance
with submitted plans. I am aware that the ity Planner can revoke thO permit for just cause. Furthermore, I hereby agree that City Officials or a designee
thereof may enter upon the property to pe ne ded....... nspe~ions. . f._ (; . ~
. .PJijI //-& -Y,l
OF PROPE OWNER/AGENT DATE
FOR ADMINISTRATIVE USE
SUBMISSION REQUIREMENTS
~mPleted APplication
. _'Y~a1e Drawing showing location of sign
~s and Specs 0 ()
ermit Fee $ J <] (permit fee is set
at time ofapplication according to approved schedule)
This is to certify that the request in the above application and accompanying documents is in accordance with the City Sign Ordinance and may proceed as
requested. This document, when signed by the City Planner or designee constitutes a temporary Certificate of Zoning compliance and allows constntction to
commence.
By
Date
Special Conditions
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24 Hour Notice for All Inspections
447-4230 from 9:00 a.m. - 10:00 am.
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..'EXPENSECHECK:
75-905/919
fl; PRIOR tAKE STATE BANK
11/6197
PAY TO THE
ORDER OF
City of Prior lake
$ ......60.00
SbttyandOO/lOO.***"'***.._"~.".***""**"*.***"*.*"'.**.."'."'''---..''.-***.**~.....*..........**.~....
DOLLARS
City of Prior lake
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CITY OF PRIOR LAKE
RECEIPT # 31441
DATE: )!! (0 fq7
---
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dollars
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$
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-:;/ Rec~ipf Cle~k for the City of Prior Lake
BUILDING PERMIT #
BUILDING PERMIT #
1,200.00
700.00
1,500.00
Building f3e-r.mit Fee
Plan Check Fee
State Surcharge
Park Support Fee
SAC
Plmb Pmt pp#
Mech Pmt mc#
Mech Pmt mc#
Swr/Wtr Pmt sw#
Pressure Reducer
Water Meter
Tree Preservation Deposit
Swr/Wtr Connection Fee
Water Tower Fee
Builder's Deposit
Other
Total
Building Permit Fee
Plan Check Fee
State Surcharge
Plmb Pmt pp#
Mech Pmt mc#
(Heating only - $65.00)
(Htg & Air - $100.00)
(Fireplace - $40.00)
(Air - $40.00)
Swr/Wtr Pmt sw #
Other
Total