HomeMy WebLinkAboutBuilding 08-0356
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C1TV OF PIllOD LAKE nU1LD1NC PRDM1T,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
n at bottom)
5C;}'1
Cf oS$"(}...--r1. dr~
Date }lee' d
(P.IO..orY
I White
Pink
Yellow
I PERMIT NO. 0 Y OS5~~~
File
City
Applicant
ZONING (office lIse)
Sl,
~t
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
&l/c!. '5 r- c.... ~ " C tJ ., S-rr v (' 1-,/ (/ I
~30'1
C/'7t? ;2~71Y!O/1 <:1 ~.2..- / S/
(Phone) (p.$ / - c:J-tJ 7 - '3 1_5 (>
(Phone)
//1N ./ Ss//~.i
TYPE OF WORK 0 New Construction ODeck OPorch
OAddition OAlteration o Utility Conne
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
III
H
2
IV V
I M
3 4
A
R
5
I
E
II
F
I
.;::b.-v I
/
ORe-Siding OLower Level FinIsh 0 Firepl,lCe
o Mise.
B
S
U
PROJECT COST IV ALUE
(excluding land)
$
I hereby certify that l have turmshcd mformation nn this applIcation which IS to the best of my knowledge true and cnrrect I also certify that I am the llWnLT or authOrized agent for the
.lbnvc-mentlllned property and that all cnnstructlLln WIll Cllnt'lfm tn 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 propeny to perform needed inSpectIOns
.~~?/~ ~S'1-7Z.0 0 ro/afttE
x
Signature
Contractor's License No.
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $ I
This Application Becomes Your Building Permit When Approved
Buildlllg Urticial
Date
Park Support Fee
SAC
$
$
$
$
$
#
#
Water Meter Size 5/8"; I",
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
-
ThiS IS to certify that the request in the above application and accompanYlllg documents is III accordance with the City Zoning Ordinance and may pnKeed as requested ThIS dlKument
when signed by the City Planner constitutes a temporary Certificate uf Zoning compliance and allows construction to commence. Before occupancy, a Certificate l)f Occupancy must he
isslIed
Planning Director
Special Conditions. if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372