HomeMy WebLinkAboutVoided Permit 09-0196 o F PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, . � � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�' �� ��������� �� x AND UTILITY CONNECTION PERMIT
V �
M��'NES��P L White Fi1e pERMIT NO �
2. Pink City Qq .. �a r
3 Yellow Applicant �' � �
Please e or rint and si at bottom)
ADDRESS � j�/ �"� '� /X/,C L/�' C'/�, ZONING (ot�'ice use)
prior L, rYl/V �537Z�
LEGAL DESCRIPTION (of�'ice use only)
LOT BLOCK ADDITION PID Z,,r-', �¢ O
� aine) / V� CK:(�li l��l� (Phone) �i� 7�$'' y�(���
(Address) �g0 �Q �'/ 11�GU� /� E �r / r` � 77,
(Company Name) J��� (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction eck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alter tion ❑Utility Connection
CODE: R.C. ❑I.B.C. O c.
Type of onstruction: I II III IV V B p ,� T COS V LTE $
Occupancy Group: A B E F H I M R S (e luding 1
Division: 1 2 3 4 5
I hereby certify that I have fi�rnished information on this application which is to the of my kn edge true nd co also ce at I am the o ner or authonzed agent for the
abuve-menhoned pro d that all consn�ucti will conform to all existing state a {ocal la s an il] proceed in ccordance with submitted plans. ware that the building
ufficial can rev s perm for just se. F ermore, I hereby agree that the city official or a sig ay enter up th o perfor ed ct s.
X
nature n c's icens o. ate
Permit Valuation 3 �� _ Park Support Fee # $
PermitFee $ $$��S SAC #
Plan Check Fee $ S �� 3 b Water Meter Size 5/8"; 1";
State Surcharge $ ., Pressure Reducer $
Penalty $ SewerlWater Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLTE C�� 4. p $ �,c� -j , �(
�
This a' Become ' g Petmii Wh Ap oved Paid ReCei t NO.
Date B
�
ate
Th1s is to rtify that t request in the above application and accompanying doc ents in accordance with the City Zoning Ordinance and may proceed as requcsted. This document
when ' by the ' Planner constitutcs a temporary Certificate of Zoning mpli ce and allows conswction ro commence. Before occupancy, a Ccruficate of Occupancy must be
issue .
..__ � V
Pl Director Date Special Condidons, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372