HomeMy WebLinkAboutBuilding 06-0726
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
] White
Pink
Yellow
File
City
Applicant
I PERMIT NO. L?& - /!J-b I
6rtl2
ZONING (office use)
/
10
L
.S-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Address) 5(/ Fl~L
i/-/ 0 ~ ct')
{760f'l1-CfC
(Phone)
e
BUILDER
(Company Name)
(Contact Name)
(Address) b
f(u
..
0- I Yl '7
----/
(Phone)
(Phone) 0 Jr! r.L '> p- ) J JJ
,-( G. 10 t ,-{ )'t-1.. "--
-e i'
TYPE OF WORK 0 New Construction ODeck OPorch ~fing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection
CODE: DI.R.C. DI.B.C. o Mise.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ ~OC?D.60
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 hlrnlshed mformatlOn 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 fe)r the
Jbove-mentlLlned property and that all construction will conform to all eXlstmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
offiCIal can revoke thiS permit for Just cause Furthermore, I hereby agree that the City official or a designee may enter upon the prope11y to perform needed mspectlons.
? 0 S- 12 /17 D- /1- (--6
Contractor's License No. Date
x
Signature
Sewer & Water Permit Fee
$
$
$
$
$
$
I $
$
Park Support Fee
SAC
#
#
Permit Valuation
Sewer/Water Connection Fee
#
#
$
$
$
$
$
$
$
$
$
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Water Meter Size 5/8"; I";
Pressure Reducer
Water Tower Fee
Builder's Deposit
Other
Gas Fireplace Permit Fee
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid
Date
r;~ 9~
"h
I ~~"J: 51793 !
Bulldll1~ Ofticial
Date
ThiS IS to certify that the request 111 the above application and accompanymg documents IS in accordance with the City Zoning Ordinance and may proceeli as requcsted TIllS document
whcn signed by the City Planner Cllnstllutes a temporary Certificate of Zonmg complIance and allows construction to commence Before occupancy, a Certificate of Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372