HomeMy WebLinkAboutBuilding Permit 10-0801 J
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CITY OF PRIOR LAKE BUILDING RM, Date Rec'd
1 \ U' TEMPORARY CERTIFICATE OF ZONING COMPL ITIANCE g,/../0 , may
AND UTILITY CONNECTION PERMIT
Nr Z NNESo
.. white File PERMIT NO .
2. Pink City /O . V S
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I S3 5 4 Vti c S ?i�� �a � /Q X5 37 2
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER -� � / - / / /
(Name) J �Q.S cv J � ev - (Phone) C -2) / W`� -
(Address) / c S R 1 8 ,. 0 • SE , (PV 1)5k6 ( akp ill 11 v S
BUILDER
(Company Name) DuBois Design & Remodeling, Inc. (Phone) i) � Ce 00
(Contact Name) 11825 Point Douglas Drive South id �) 0161.0t5 (Phone) S T5B `O B
(Address) Hastings, d 5 033
TYPE OF WORK ❑ New Construction ['Deck ['Porch [Me-Roofing 542.e-Siding EJLower Level Finish ❑ Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B op
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ 2., , 20 1
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 my 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 local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed in pections.
X 9 176(-°--- J Igo 9 ate
Signature Contractor's License No. ate
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 # $
Plun Water Tower Fee # $
Me . Builder's Deposit $
Si Other $
Gas TOTAL DUE $ <r q °'I,5
This Application Becomes Your Building Permit When Approved Paid 1 /. 1 eipt No. �p / j53
Date 7, /'1- /0
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 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 S.E., Prior Lake, Minnesota 55372