HomeMy WebLinkAboutBuilding Permit 09-0773
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09/28/2009 15:49
7635712746
JOHN PEDERSON CONST
PAGE 03/03
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF WNINO COMPLIANCE
AND UTILITY CONNECTION PERMIT
~.~
ADD~S
I!, . n _" N.E.
I LEG~~. BSCRlPTION (office use only)
Lar ; BLOCK ADDfI10N
OWNE ' J
(Nam~) : h
i :
(A~,I
..~ ~.
~,l'l!IJ< QljI
}. Y.lkIW ...~
I PERMIT NO. O~ 0773/
II ZONmG,__> I
" :.
Pill
(Phone) 95?-;;Lll-SS03
The.
(Phone) 'l(Q3- fRlJt-l'?OO
(Phone) '1 C)C\.YV'\ e...
~ a . WORK 0 New Comttuction DDeck DPorch ~Roofin8 Dh-SidD;Jg DLower Levd Finish 0 Pirep~e
!: DAdditioJ;l DAJcetatlon DUtWty Connectlon
,
o Mise;
I nmIVVAB
E FHI MRSU
1 2 3 4 5
PllOJECf COSTIV ALUE $J2..J~ .lorl
( f!W('hlllfl"'81aod.)
I b=lry : . that I hln<> Iiuniobcd ~tloD on ~ appldcio... wlUch is lID lbe &>at of my kn~ _ aM. 000'-' 1 4Ibo ocrIilY ibM I am !bco <>wI:I<< QI' -\IlboriucI A&'M1 fOl' the
above-mtn" PJIlPUlY and !bat aU collllrUdion wiD OOnfOIDl \tI an aistinc 11m Jud ~ ~W$ al\d will ~ b\ ~ v.iJb -.bmittl!d~. 1."" aware ~ tbco h\ailding
offitW "*n 11m ~ jb$t allae. Fut1hermort, I hmby agttt tbat !be city official Of a dcl8ignce may eo_ upon the: property \tI pafurm IICCldcd inapc:lctiom.
X , ' .~ \J ~O~ l42t..RI<-(J C\.\ \ \Q~
'Signature Conuacmt. L~ No. Date
Pennit:F : S
I I'
PIan ~~~ Fee $
State S, $
PenaJtt $
Plul'I'l",\ng ;emUt Fee $
Mecha,uc Pennit Fee S
, '
Sewer &; ,ater Pmnit F<< $
Gas F4'ev i$a: Pennit Fcc S
PlUk Support Fee
SAC
WaterMeter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Wa= Tower Fee
Builder's Deposit
Other
TOTAL DUE
# $
# $
S
$
# $
# $
$
$
$ 7(,. 0
/J
_:Zf:NO' 9r'1"f
'I1ds A .. Becoas Your BllildiDg Pc:nDk WJItIl A~04
I
Tho i$ ~ . that tbe n:quat in the; ,bIM: ,ppJicalion and ~8 doturnenrs Is in aa:ot'llana: wiIh die Cb:y Zoning ~ and may proem! u 1'CQ\ICIlI:d. ThiB document
when ai&!Ied y!be City Planner COlI8tiIulrli a lm1poouy CcrIiIicaIX: of ZoniDg COIDp~ anti ~W$ I;OIIll~QIIIl1 wmmeo"" .Befurc, ~~. _ O!lti/"lCIIli! ofOa:"l"'nq' ml.l:st be
i$$ucd.. i
t:;::;:z~"?
- Official
Date
PIuDiD: Dirwt(Jr
IlIIre
24 hOll,r I;totice for ah bupcctiolll (951) 447-9850, to (952) 447-4245
~ Dakohl S1reet s'B.. PrIor Lab, Mb;Jnl!$ota 5S37~
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