HomeMy WebLinkAboutBuilding Permit 11-0056 of PRI CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 4 Z9 / J
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x AND UTILITY CONNECTION PERMIT
� I Whire File PERMIT NO _
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3 Yellow Applicant ` ���((JJ!
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
q 1 '6 Gra wan 0( G, 7
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER fi t e (Phone) ? 5/
(Name) �� Z /van � Phone 5z z 3 q /
(Address)
1
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction EDeck ❑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 AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR 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. I also certify that 1 am the owner or authorized agent for 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 building
official can revoke this permit for lust cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X '41111P_ _ ` l /Z9 //
/ . i : cure Contractor's License No. Da e
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; I "; $
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 $
This Appli . tion - es Your Building Permit When Approved Paid Receipt No.
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A lt !di g 0 tier al Date
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This i •rti fY ■ at the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance Ad may proceed as requested. This document
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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
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5` l'` Scott County, MN
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This drawing is neither a legally recorded map nor a survey and is not Map Scale N
intended to be used as one. This drawing is a compilation of records,
information, and data located in various city, county, and state of ices, and 1 i nch = 27 feet
other sources affecting the area shown, and is to be used for reference W E ., .ry ,
purposes only. Scott County is not responsible for any inaccuracies herein M ate
contained. If discrepancies are found, please contact the Scott County p y' ; S
Surveyors office. 9/29/2011 S