HomeMy WebLinkAboutBuilding 05-0775
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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
$ 91'1 /~oY~~~1-
LEGAL DESCRIPTION (office use only)
LOT I-I~LOCK
While
Pink
Yellow
File
City
Applicant
\ PERMIT NO. (J~-IJ?JI
ZONING (offiCe use)
ADDITION
PID
OWNER \
(Name) ~ \. ,",v","
r:-J .
r'-E-~
(Phone)
7S-2
'1'-(, ~<i~,
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction OOeck OPorch
OAdditlOn OAlteration OUtility Connect
ORe-Siding
OLower Level Finish
o Fireplace
Re-Roofing
n
CODE: OI.R.C. OI.B.C. o Mise. .--
Type of Construction: I II III IV V A B PROJECT COST /V ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
1 I hereby certity that I have furOlshed Information lm this applicatIon which IS tll the best of my knowledge true and correct. I also certIfy that I am the owner or authOrIzed agent telf the
I ab"vc lllne,! P"'PCIty and th"t "ll constIuctllln Will conform tll all eXistIng statc and locall,lws and Will pIoceed In accOldance With submllted plans I am "W"le that the bUIldIng
Ir~.CI"I,;:r; oke rim peImlt tOl Just cause FUllheImore, I heleby agree that the City offICial or ,I :~nee m"y enter upon the propeny t<J pel form nee_~,ed rnspectIon~ ._
,~ '. _~_, '> L c, 1 'i-l t; I t (,-1 c.'I..S:
Stgnature Contractor's License 'fio date
Permit Valuation
Permit Fee $ -
Plan Check Fee $
State Surcharge $
Penalty $
!Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Penntt Fee $
\ This Application Becomes Your Building Permit When Approved
I
\ lluildlllg OIYI(lal Date
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 $ '/0. -
~id
Date
"'11g:;_ /
- .J- 5
I ~~";~'9lXJ/O
ThiS IS to certify that the requl'st 1Il the above application and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested. ThIS document
when signed by the City Planner constitutes a temporary CertifIcate of Zonmg complIance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
isslled
Planning Diredor
Special Conditions, if any
Date
24 hour notice for all inspections (952) -t-t7-9S50, fax (952) 4-t7--t2-t5
16200 Eagle Creek Avenue Prior Lake, MN 55372