HomeMy WebLinkAboutBldg Permit 01-1158
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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I. White File
2. Pink City
3. Yellow Applicant
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PERMIT NOol!JlJ /15'i
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(Please type or print and sign. at bottom)
ADDRESS
IJ I L yO A/S-f-.
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LEGAL DESCRL.t' nON (office use only)
5 &0::4
LO~ BLOCK / ADDITION r1J(J tJ-LA YJ/Jd J);L/h PID;:;g-oll- t1J<::J-Q
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g;::~R ~ 'i'nc f7 ~ (phone)
(Address)
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BUILDER f f ,,~~ ~ ,/ ~ '- _ _ 1'_ .. _ -;;-'
(Name) ~14LL1JI~ (~~~
(Contact Name) ~.~
(Address)
(Phone)
(phone)
9.5c:2 -t"~ 7K'R J
6a1-9~O-1//9S"
o Misc.
CLOSE FILE
10/28/03 MP
OAddition
~e-ROOfing
OAlteration
ORe-Siding
TYPE OF WORK
o Porch
OUtility Connection
LUE (excluding land) $
I hereby certifY that I have fum,.HCu ffirormation 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 upon the property to 0 needed inspections.
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.() OtJ'f J1 t) ~R
Con1ractor's I.ici'eDse No.
tJ4/5;o/
Date
I Permit Valuation I Park Support Fee # $
I Permit Fee $ 7L1~ 7~ I SAC # $
I Plan Check Fee $ I Water Meter Size 5/8"; I"; $
I State Surcharge $ /'J-~ I Pressure Reducer $
Penalty $ I Sewer/Water Connection Fee # $
Plumbing Permit Fee $ I Water Tower Fee # $
I Mechanical Permit Fee $ I Builder's Deposit $
I Sewer & Water Permit Fee $ lather $ rlblO~
I Gas Fireplace Permit Fee $ I TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid rzi-/fp ;f/r) Receipt No. C/U''fbl
Date (O-/~-UI By ~ ____
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 te....Mwy 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