HomeMy WebLinkAboutBuilding 05-0658
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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I h 0 77-1 ..s~r
1 White
Pink
Yellow
File
City
Applicant
I PERMIT NO',5- 05&
c -
-:>t;..
ZONING (office use)
K./
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION S ce--r sri;
(Phone)
447. -57)58
OWNER
(N ame)
I'1&S6N t5KIN!<-
(Address)
PID 25.
'3'7. Cl20. 0
BUILDER
(Company Name)
(Contact Name)
(Address)
nGSEN dlu/N Ie
-1-47_5058
(Phone)
(Phone)
ORe-Siding OLower Level Finish 0 Fireplace
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition OAlteration OUtility ConnectIon
I
.: Pt471 0 OOOIt:-
CODE: DI.R.C. DI.B.c. }IMiSC ~A5.$ l~tll /11 OOl-V
Type of Construction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
I hereby certifY that 1 have furnished 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-mentIOned property and that all cllnstruction 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 Clty official O[ a designee may enter upon the prOpeJ1y to perform needed mspectlOns
x
Signature
Contractor's License No.
Date
Permit Valuation 2,500.00
Permit Fee $ 71-- 75
Plan Check Fee $
State Surcharge $ 1-2-5'
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
/7 . ~ r
&. '-r'.., /,
, . ~(~. ~/-
. BuddIn!! Onlcial
7/II/oS"
, Date '
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
BUllder's Deposit $
Other $
TOTAL DUE $ 7h.OC)
~id
Date
-l?- - .,/
"1~/J-'7
f, -
I Receipt No. [.1 q'7~ 1
By ~
ThIS IS to certifY that the request In the above application and accompanymg documents is In accordance wIth the City Zoning Ordinance and may proceed as requested. Tim document
when signed by the City Planner constItutes a temporary Certificate of Zoning compliance and alluws construction to commence Before occupancy, a Certificate of Occupancy must be
ISsued
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