HomeMy WebLinkAboutBuilding Permit #12-588 oF rRt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
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,,.�.. z �;�, �;, PERMIT NO. — L _ �
�. 3 Yellow Applicant
Please e or rint and si at bottom) �`
ADDRESS ZONING (o�f'ice use)
_ ��
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) � G-- (Phone)
(Address)
BUII,DER
(Company Name) (Phone)
(Contact Name) F�cv l� �7cG'/ �`� (Phone) � �—_ � �Z-� cD��
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-RooFing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �A(teration ❑Utility Conn t�
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constcuction: I II III IV V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 have fi�mished information un this application which is w the brst of my knuwlcdge true and correct. I alsu certify that 1 am the owner or authonud agent for the
above-menuoned roperty and that all onstructio will conform to all existing stare and local laws and will proceed in accordance with submittcd plans. I am aware that thc buildmg
I ufficial can revoke is per for just c urthermo I hereby agree that the city official or a designee may enter upon the property to prrform necdcd mspecnons.
X
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 $
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This plica n o s Yow Building Pemtit Wh n Ap ved Paid ReCei t NO.
� Date B
Bud m� fticial ate
Th�s u to certify that thc requcst in the above applicanon and accumpanying documents is in accordance with thc Ciry Zoning Ordinance and may proceed as requcsted. This document
when signed by the Ciry Planner constirotes a temporary Certificate uf Zoning compliance and aUows construction to commence. Before occupancy, a Certrficue af Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372