HomeMy WebLinkAboutBuilding Permit #12-221 � ❑ O� (7 O�O�OO � O D ZA
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o � rtt� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE `� _ -� � , � �
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AND UTILITY CONNECTION PERMIT
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A►jNNESO�N I. White File �
z �;�, � PERMIT NO. ��
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZONING cot� useJ
, � l� C1�i,/�i C, J !X �'�-
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
o�R , �/ ��� -�21�a
(Name) -� ��'�, ��8 f-<% i' i' . (Phone)
(Address)
BUII.,DER '� /^� �! //���
(Company Name) ' � ��' '� C�'n�• (Phone) �0 � a-'�D� `?7' /� _
(Contact Name) Q � T�r- �i (Phone)
(Address) t� �C G •- � �
TYPE OF V�ORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Consttuction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hcreby certi'ty that I have fumished information on this application which is to the best of my knowlcdge true and coRect I also certify that 1 am the owner or authonud agent for the
above-menuoned propeRy and that all construction ill conform to all existing state and Local laws and will proceed in accordanee with submitted plans. L am aware that the buildmg
official can revoke this permit for just u e Furt re ereby agree that the city official or a designee may enter upon the property ro perform necded mspections.
X ���5 « �3 43��-�/oZ
Signamre Contractor's License No. Date
Permit Valuation '�,, �` 4 � U Park Support Fee # $
Permit Fee $ �� -75-- SAC # $
Plan Check Fee $ Water Meter Size 5/8"; i"; $
State Surcharge $ S 3-U 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 $
This Application Becomes Your Building Permit When Approved Paid �1 ReCei t No.
Date � � 3 � �• B -
3 - 3U-),1-.-
Buildina Ufticial Date
This �s to certify that the requcst in the abuve applicanon and accumpanying documents is in accordance with the Ciry Zoning Ordinantt and may proceeA as requested. Th�s document
when signed by the City Pianner consnmtes a temporary Certificate of Zoning compliance and allows construction ro commence. Before uccupancy, a Ceruficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372