HomeMy WebLinkAboutBuilding Permit #12-475 oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � 1 Z¢��
.. X AND UTILITY CONNECTION PERMIT
� �
a�HNES��� �. Wh��e File pERMIT NO. �/
z. rc�k c+cy [/�
3 Yellow Applicant y 1 T
Please or rint and si at bottom
ADDRESS ZONING (ot►'ice use)
� �7�C� �O�C ���L ��� /L_-
LEGAL DESCRIPTION (ofI'ice use only)
LOT BLOCK ADDITION PID
OWNER� ,,���
(Name) +r��Q 4� �t 1�Y.1� ���� (Phone) � � �O 1 �� — � ��o�
(Address) � � (�
BUII,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. �Misc. �4�'�«�� � �
i �
Type of Constcuction: I II III IV V A B pROJECT COST/VALUE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certif'y that i have fumished information on this application which is to the brst uf my knowlcdge trur and correct. I also certify that 1 am the uwner or authur�zed agent for the
above-mention property and thayyyqqq Il con on will conform` to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
off'icial ca re ke t is ermit fo�ca F hermore, 1 hereby a ree that the city official or a designee may enter upon the property to perform necded msp tions.
X � 1�
Signa Contractor's License No. Dat
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer s h $ Z �(�
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 DiJE $ LQ _(�
_ _ _. _ I
This Application Becomes Your Building Pernut When Approved Paid Recei t No. ^ — ' - ' `
Dat B I
J
Buildin � Ut7icial Date -� .`....°-.,. ...__ .
_
_ _....._..__ __ _,. _ .
This �s to certify that the mqucst in the above applicauon and accumpanying documents is in accordance with the City Zoning Ordinantt and may protteA u requested. Th�s dcxument
when signed by the City Pianner cunstuutes a tempurary Certificate uf Zoning compliance and allows conscruction to commence. Before uceupancy, a Cett�ticate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-98.50, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372