HomeMy WebLinkAboutBuilding Permit #11-1083 �❑� n O�O�O❑ � O D Zn
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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� AND UTILITY CONNECTION PERMIT CD .�� ��
U �
���'NES��� I whire File
Z �;�� � PERMIT NO. G
3 Yellow Applicam �
Please e or rint and si at bottom)
ADDRESS ZOI�TING (ottice use)
��35�t-153s� ,�s . �s �--�n,� �.-�� ��
LEGAL DESCRIPTION (off'ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUII.DER �l �' � ►'1�1� � J / ( ) 7� � �. 3 / �/ a 3 �
(Company Name) � � Phone
(Contact Name) � t+S �� �m t 7"� (Phone)
(Address) ,��� a'�s��1S u���
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch -Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conne ion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: 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 hereby certi'ty that I have fl�mished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the owncr or authur�zcd agcnt for thc
abovamenhon property and that all construction will conform ro all existing stare and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can re e this permit for just cause. Furthermore, I hereby agree that the ciry official or a designee may enter upon the property ro prrform necded inspections.
x � �� 3��� l� — 1 `l — ��
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 DiJE $
�
This Application Becomes Your Building Permit When Approved Paid . - � Re ' t No.
Date B
Buildim� Utlicial Date
This is to certify that the requcst in thr abuve applicanon and accompanying documents is in accordance with the Ciry Ziming Ordinantt and may proceeA as rcquested. This document
when sigrrcd by the City Planner consututes a rempurary Certificate uf Zoning compliancc and allows construction to commence. Befure uccupancy, a Ceruficate of Occupancy must lx
issucd
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