HomeMy WebLinkAboutBuilding Permit 08-0567 J
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04 rrtj CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �• , �
�' ��' � AND UTILITY CONNECTION PERMIT G
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���'NeS��P I. White Pile
Z �;�� � PERMIT NO. Q� D J c-�
3 Yellow Applicant /
Please e or rint and si n at bottom)
ADDRESS ZONING (ofeice use)
3l� I J �1 � .e �rs d
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) O Q � �" (Phone) � �S� �- a 30 � �.g�G
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(Address) p 8 a , �jd V'�—
BUII,DER
(Company Name) (Phone)
(Contact Name) � (Phone) r?•�� 4/�—
(Address) SioL. �'+�
TYPE OF WORK ❑ New Constructjon ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition (�Alteration ❑Utility Connection
CODE: ❑I.R.C. �I.B.C, ❑ Misc.
Type of Construction: I II III IV V A� pROJECT COST/VALITE $*j $�0 ��
Occupancy Group: A QB E��' H I M R U (excluding Iand} ,
D i v i s i o n: 1 2 3 4 5
I hereby certify that I have fiirnished information on this application which is to the best of my knowtcdge true and correct. I also certify that I am the owncr or author�zed agent for the
above-ment�oned property a 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 p� it for se Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed mspections.
X ' ,Q.._- �/�r' � 8
Si nature Contractor's License No. Date
Permit Valuation �O . � Park Support Fee # $
Permif Fee $ � . SAC # $
Plan Check Fee $ •` Water Meter Size 5/8"; 1"; $
State Surcharge $ — Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other, $
Gas Fireplace Pe �t Fee $ TOTAL DLTE $ �.LL� `
This Ap i o� comes Your Building Pernut Whe Ap oved Paid ZZ. 9 Re ' t No. O
Date , (/ B
` ildina licial te
This is to certify that the request in the above application and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. This document
when signed by the Ciry Planner consututcs a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning D'uector Date Special Conditions, if any
24 hour notice for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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