HomeMy WebLinkAboutBldg Permit 01-0963
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AN~ UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT I~LOCK ADDITION
OWNER
(Name)
(Address)
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Andros
1. White File
2. Pink City
3. Yellow Applicant
Date Rec' d
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PERMIT NO. 01- ~ q ~:3
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(Phone)
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Pw0f7ft1;r
(Phone)
(Phone)
BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WO CLOSE FILE
10/28/03 MP
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o Porch
~-ROOfing
OAlteration
ZONING (office use)
PID ZS-Or7-IJU-O
ORe-Siding
OUtility Connection
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
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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
$
$
$
$
$
$
$
$
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This Application Becomes Your Building Permit When Approved
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Building Official Date
:eplace
OAddition
#
#
#
#
$
$
$
$
$
$
$
$
$ "II,. uV
Receip)t1J 4rJ-\3 c..,
BY?,
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
_ _ _ _ . COST IV ALUE (excluding land) $
I Park Support Fee
I SAC
I Water Meter Size 5/8"; 1";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
I Paid
I Date
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Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245