HomeMy WebLinkAboutBuilding Permit 09-0017 M.
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o P Rio, � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
e TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Q AND UTILITY CONNECTION PERMIT �Z' 67 A ''NN E so:
I. White File I P NO I
2. Pink City 09 0 O/ y
(Please type or not and sign 3 Yellow Applicant
T /
print gn at bottom)
ADDRESS .
ZONING (office use)
3 / 2.— i /' i2 C. - rr%
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ,f
(Name) . ..,h d Lc■Gr/./"s
(Phone) 6/2 - 86S — �5".2 89
(Address) 3,.2..2 / .6/ de `J G✓ '.6' G /6`'
BUILDER / /
(Company Name) C- f/fiS7 rJ 7; Cep'g g./ ,.j 09�y /;Z(Phone) 7 6J —c_5—y./- 43e
(Contact Name) ,6i 7/&Z. (Phone) f i
(Address) 9Jo0 /.) 7 /- ,y /!/_
� e , .. 4 9/.."7-9.0 . 4--7"// `,j ,, c5
'/
TYPE OF WORK ❑ New Construction ['Deck ❑Porch [Me- Roofing ,Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utilit Connection
CODE: ❑I.R.C. ❑LB.C. ❑ Misc.
Type of Construction: I II III IV V AB
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ ,720
Division: 1 2 3 4 5 (excluding land)
1
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 inspections.
X �11"+^✓// Signature 0 .& �. —2 — Z27
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&nnection Fee #
Plumbing Permit Fee $ Water Tower Fee
Mechanical Permit Fee $ Builder's Deposit
Sewer & Water Permit Fee $ Other
$
Gas Fireplace Permit Fee $ TOTAL DUE .✓� !
$ 6
This Application Becomes Your Building Permit When Approved Paid /-
�(� - I Re pt No. .5 03
Date /, f-7 7 B .
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 Prior Lake, MN 55372