HomeMy WebLinkAboutBuilding Permit 11-1122 - O oX n 00000 I) o > 2
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OF PRI� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
a TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /0 2 /1
PERMIT NO
AND UTILITY CONNECTION PERMIT
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41'Nitesol� I white File
2. Pink City // / Z Z
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3 q 93 /-4dizr, Payas i),4.,/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER n > .
(Name) Pet e / t /I Mae, C..4,, /vw (Phone) gS - 'fy'— (
(Address) 3 N3 M4 fir keg,"
BUILDER / 9T - lige - W - Or
(Company Name) (� Y► S c -1o+ --• -in (--- (Phone)
(Contact Name) 6 )1 y/ 14,44_4(ros- (Phone)
(Address) (D 4 117 / S'C) " 51 'ex
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TYPE OF WORK ❑ New Construction ❑Deck ['Porch ['Re-Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition Alteration ❑Utility Connection D _ . o Z d . I, ,,,a
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner or authorized age 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 b actin
official can r - ke this p tni . Just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 44 ?0c AO ety /u —/4 —//
Signature Contractor's License No. Date L_.------
Permit Valuation 3 o , 00 Park Support Fee # $
Permit Fee $ 2� SAC # $
Plan Check Fee $ /&', Z( Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / rt Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ J S7.1 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ ?k. Z5
This Applica � i . ecomes Your Building Permit When Approved Paid /'( - 1. 1 Receipt No.4 1 7/
Date lit y
G, /0.Z¢.,J g
• iilding Official Date
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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 temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must he
issued
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372