HomeMy WebLinkAboutBuilding Permit 11-0710 n
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i 0 l . . . P Ri o p CITY OF PRIOR LAKE BUILDING PERMIT,
c TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
�
� AND UTILITY CONNECTION PERMIT 0 , ¢- ti
4, NNEso
I. White File
2. Pink City PERMIT NO- / l 6
Please .e or . rint and si : at bottom) 3 Yellow Applicant
ADDRESS 0
/9A RidQ I
` D J� � ' " �/ ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OW NER,-^
(Name) 1 rx�, r . . 1 1. . i'1
(Phone) 15i -8/s 85
(Address) Ng /,
i fs N G I✓ - t t/ 4. e /)1,1/ 5 7
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_ MAW:
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(Company Name) • I.GYlg11FlA G k t? VL
I-nc,_ (Phone) 952: L103 -- Too
(Contact Name) .e• ii � • ' a l.c...
n
(Phone) 6 l2 -36 3 - G 19-0
(Address) 9 R 2
/t
L., • ' Al 5 I • I !L * r3,. /I /J .5 "
TYPE OF WORK O New Construction ❑Deck
❑Porch ORe- Roofing 12e- Siding ['Lower Level Finish
['Addition DAlteration OUtility Connection ❑Fireplace
CODE: ❑I.R.C. ❑I.B.C. -P�iAJ
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NI Misc. 1 n otv
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I MR S U PROJECT COST /VALUE $ /0 365
i Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of m knowledge true and correct. I also certify that I am the owner or authorized agent for the
above - mentioned property and that all construction will conform to all existing state and I 1 laws and will proceed in accordance with submitted plans. I am aWare that the building
(Abe revoke this per it for just cause. Furthermore , I hereby agree tha he city offi r a designee may enter upon the property to perform needed inspections.
C,✓ � � -725/
Signature
Contractor's License No. te �/
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 ; $ 7 9 71,E
This Application Becomes Your Building Permit When Approved
Paid • / Fir.!.
Date i.t No.
'i
Building. Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may
when signed by the City Planner consulates a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,
issued. Y proceed ed as requested. This document
must
a Certificate of Occupancy must be
Planning Director
Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 Special Conditions, if any
4646 Dakota Street Prior Lake, MN 55372