HomeMy WebLinkAboutBuilding permit 09-0642
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
~- 2.--I:lIf
(Please type or print and sign at bottom)
I ADDRESS
50 G a liop~
5+
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
White File
Pink City
Yellow Applicant
PERMITNO.tJ9.. 0" ~
ZONING (office use)
r (" : ov k (-€
I OWNER
(Name) c..0I. r I",
(Address)
::r e,,\ 'S 0 v-.
(Phone)
b S I -.~ 0'3 - 1i" 1731
BUILDER
(Company Name) W ~ H c..o" S..J-"'u c.... i-: -.....
(Contact Name) ki\ L\ ~-+1Io'\. J""" If; I r'l ~" .
(Address) l1N' J:l M.ct
TYPE OF WORK 0 New Construction ODeck
OAddition OAlteration
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV V
HIM
234
A
R
5
(Phone) (;, 11 - $6, -'-( <{ 37
(Phone)
ORe-Siding OLower Level Finish 0 Fireplace
o Misc.
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby certifY that I have filmished mformation on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or authoflzed agent for the
above-menuoned property and that all construction will conform to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
offici I ca~ev this per it for Just cause Furthermore, I hereby agree that the City official or a designee may enter upon the property to perform needed mspectlOns.
X ":10 r3S 4 30 ~ -;).C-[ -Oc:r-
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 $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Pennit When Approved
Building Ofticial
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 $
ThiS IS to certifY that the request in the above applical10n and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. ThiS document
when signed by the City Planner constitutes a temporaty Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372