HomeMy WebLinkAboutBuilding Permit #12-485 y ❑ p� C� O��DOO � O A NA
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��f���P CITY OF PRIOR LAKE BiTILDING PERMIT, Date Rec'd
� �' '' ��� \ � � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" �;i � AND UTILITY CONNECTION PERMIT
�
� E S��
1. White File ��
z�nk �; PERMIT NO. 1�
3. Yellow Applicent
(Please e or rint and si n at bottom)
ADDRESS ZONING (ofsce use>
-�� 3 3 dn T.° S�"
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER .�- _
(Name) � 1 .� � n �.. �.4 ��a (Phone) � - `� y � 3 73 �'
(Address) (Q 3 c �
BUILDER �+
(Company Name) � C.. �1 e n cct �(�-'.� - (Phone) T� a' a 7? ��/
(ContactName) l(� ��.� ��y��.�.�-�.-�� (Phone)
(Address) a r f S' - 7� r
TYPE OF WORK ❑ New Construction ❑Deck OPorch ❑Re-Roofmg ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition ❑Alteration DUtility Connection
CODE: �I.R.C. ❑I.B.C. �,Misc: � e e � 4 � � �'" ` '� ° v `� S
Type of Construction: I II III N V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $� 5�� J�
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished informa6on on this application which is to the best of my Y.nowtedge true and correck I aLso certify that I am the owner or authorized agent for the
above-men6oned property and that all consavc4on will wnform to ad exisdng state and local laws and will proceed in acwrdance with submiUed plans. I am aware that the building
official can revoke this pemut for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
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� cr.__�� C-r �-�-o�� � G� 3 S 3 LQ 9 5 "� /�..
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 $
perialty $ 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 BuiIding Permit When Appmved Paid R i t NO. �
Date — � ('Z.._ B
Buildin Official Date
This is to certify that the request in the above application and accompanying documenu is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consatutes a temporaty Certificate of Zoning comp[iance and aliows conswction to commence. Before occupancy, a Certificate of Occapancy must be
issued.
Plamiing D'uector Date Special Condirions, if any
24 hour uodce for aU inspections (952) 447-9850, faa (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372