HomeMy WebLinkAboutBuilding Permit #09-0109 oF eR� CITY OF PRIOR LAKE BUILDING PERMIT, ��"���e �'e
� y T E M P O R A R Y C E R T I F I C A T E O F Z O N I N G C O M P L I A N C MAR �� 200�
.. � AND UTILITY CONNECTION PERMIT
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�'�Nxeso�P i. wn��e File pERMIT NO
2. Pink City / �
3 Yellow Applicant
Please e or rint and si at bottom
ADDRESS � � O �� � � O �� � ���� / ZONING (oetice use)
1N
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
Buu,DER PAT FRIEDGES CONSTR.
(Company Name)_ 612-490-H69S (Phone)
(contact Ivame) _ 21731 BENTLEY CIRCLE (Phone)
(Address) JCIRDAN, MINNESOTA 55352
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Conne ion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fiirnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or author�zed agent for the
abuve-menhoned p rry and that all constructio 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 revo thi ermit forjust c� , I hereby agree that the city official or a designee may enter upon the property to perform necded inspections.
X -� ��
Signature Contractor's License No. ate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee Water Meter Size 5/8"; 1"; $
State Surch rg $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing it Fee $� Water Tower Fee # $
Mechanical Per ' $ Builder's Deposit $
Sewer & Water Perm F $ Other $
Gas Fireplace Permit Fee $ T $ �--
This Application Becomes Your Building Pernrit When Approved p' Recei O.
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Buildin � Otlicial Date
By
Th�s u to certify that the request in the above application and accompanying documents is in accordance with the City o� r nce and may proceed v requcsted. This document
when signed by the City Planner conshtutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Ccrtificau of Occupancy must be
issued
Planning Director Date Special Conditions, if any
24 hour notice for xll inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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