HomeMy WebLinkAboutBuilding Permit #12-082 �❑❑ n O O�O❑ = O � Zn
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oF pR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��� Z
.. ,� AND UTILITY CONNECTION PERMIT
v �,
��HNIESO�� 1. White File � � _ `� ��7
Z � � PERMIT NO. ��
3 Yellow Applicant �.1
Please e or rint and si at bottom)
ADDRESS ZOI�TING (ot��ce use)
� �. .� � ' JYI�' .�5 3
l� �� 1 rx �. �� �— ��r r�, r� � c.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OW1vER t
(Name) � 1,� a r.1�,� v^ v���- ( r-a+ 'S (Phone) 9 S 2— y'� 7—! 718
(Address)
BZJII.,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 ❑UUlity Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALLJE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fumished inFormation on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner or authar�zcd agent for thc
abuve-menao�ed property and that all construction will conform to af1 existing state and local laws and wi11 proceed in accordance with submicted plans. I am aware that the buiidm�
offici n revoke this ermit f just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property ro perform necded mspectiuns.
X �, -3- / �
Signatum Contractor's License No. Dace
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 $
.
This Applica omes Your Building Permit When Approved Paid eCei t NO.
Date � �
�7 - �� . lZ
i in � Ui'ticial D�Ie
Th�s is ro certify hat thc requcst in the abuve applicanon and accumpanying documents is in accordance with thc City Zoning Ordinantt and may proceeA as requcsted. This document
when signed by the City Planner consntutcs a temporary Cercificate uf Zoning compliance and allows construction tu commence. Before occupancy, a Ccruficate nf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc tor all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372