HomeMy WebLinkAboutFence Permit 11-0012 of rR4a� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
r: ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE j
AND UTILITY CONNECTION PERMIT � � C/V
4"I 'VNEB 61 � I. White File
z Pint city PERMIT NO. I I I '2..__-
3 Yellow Applicant
(Please type or print and sign at bottom)
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ADDRESS () ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER---
(Name) 1 -+ - =16- ___.. q ' twf r2- (Phone) (�0 9 - TZ
(Address) ( (,230 �Rt fit Cr Nw f' 'ole_ Le.vc.. /k -kk.) E 5392
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch DRe-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
['Addition DAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
X 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 building
official canes xak to vma for . ause FurthermTre, 1 hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X _,.,
Signature Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit 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 Permit Fee $ TOTAL DUE $ l 1
This lie t on B .. Wilding Permit en • 'proved Paid
Date Receipt No.
i
By
■ ■ 5
IF :uildins 01 - - ial D, e
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 be
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