HomeMy WebLinkAboutPlg Permit 01-1068
(Please type or print and siJm at bottom)
ADDRESS
3Jho
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY C1G'~CA-a~G COMPLIANCE
AND U r':' r I "I RMIT
~ ~i~ ~::y PERMIT NO./')/_ /0/ cY
3. Yellow Applicant L./ CO 0
Date Rec' d
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ZONING (office use)
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tAJooArl,)ck
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LEGAL DESCRIPTION (office use only)
LOrd~LOCK I ADDITION {v~ '8 rd
OWNER
(Name)
fA1 c rJf)n~ Ir!
(Address)
BUILDER A () I /
(Name) /Jt ( C ') ttl t1 C1 (C7
(Contact Name)
(Address)
TYPE OF WORK
o Misc. fAI t'tle/"
PIrQS- 337- ~;J.lf-()
(' 01'1 (" tI/r./ c., 17 01/1
(Phone)
( 0 t4 5 )f1"1.JC 17 0 t/I
(Phone)
(Phone)
o New Construction
ODeck
o Porch
ORe-Roofing
ORe-Siding
DLower Level Finish
<; 0 .f::/P/J tpr
o Fireplace
DAddition
DAlteration
DUtility Connection
PROJECTCOST/VALUE (excluding land) $
I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or
authorized agent for the above-mentioned property and that all construction 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 city official or a designee may
enter upoJl1te property to perform needed inspections.
X rJa 1ft!- /lll rJlf\~ tI LJ h 1..4/ C q - ~ h- 0 I
Signature Contractor's License No, Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
$
$
$ /5D
$
$ 39-50
$
$
$
I Park Support Fee
I SAC T FOR INSPECTION 0
I Water Meter Size 5 REQUES CONTRACTOR. N
I Pressure Reducer SE~~~~SE _ CLOSE FILE
I Sewer/Water Connect RE
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
#
I"
#
$
$
$
$ .L/t)~cJU
This Application Becomes Your Building Permit When Approved
I Paid
I Date
. ,UU ,
~- O-h-n/
Receipt No. Lfr) b i7J
By (}11 -'
(J~
Building Official
Date
This is to certify that the request in the above application 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 temporary 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