HomeMy WebLinkAboutBuilding Permit #12-497 S ❑❑ C� O�DODO '� O D yA
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o � PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE r
., x AND UTILITY CONNECTION PERMIT �•�`" �� Z "
U �
'�j i. White File - �.
2 �;�� � PERMIT NO.
3 Yellow Applicant
Piease or rint and si at bottom)
ADDRESS ZONING c�t�,�� �se)
� �' a1 � �A��` e�hxz � �-qvl t'�
LEGAL DESCRIPTION {office use only)
LOT BLOCK ADDITION PID
� ��'�� � �U�. �.���� �YI� �� (Phone}
(Address) �! r�L �S l� �''''�-
BUII.,DER �, J � � � 1 � d-3 � — g`1 � �
(Company Name) �S (Phone)
(ContactName) � r �S� (Phone) ��l Z- ���-" yla3
(Address) ^� Q 1 a � G � / �M 4�- /H�*�� ''� � � �c. �`1°I ��n �" y
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Firep[ace
❑Addition ❑Alteration ❑Ualiry Conne i n
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 have himished information on this application which is w the best of my knowledge true and correct. I alsu cectify that 1 am the owner or authonzed agent fur the
abuve-menuoned property and that all construction will conform to alI existing scace and local laws and will proceed in accurdance with �ubmittcd planti. I am aware that the buildmg
official can revoke this permit r jus ca e utthermore, I hereby agree that the city officia! or a designee may enrer upon the property to perform needed mspectiuns.
I X `�z �iy�p3 �'aq- i�
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 $
Penatty $ 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 DiTE $
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This Application Becomes Your Building Permit When Approved Paid R Cei t No.
Date
BuilJin � Ufticial Date
This is to certify that the request in the above applicauon and accompanying documents is in accordance with the City Zoning Ordinantt and may procerci as requcsted. Thn document
when signed by the Ciry Planner consLtutes a temporary Certificate of Zoning compliance and allows consn'uction tu commence. Before occupancy, a Ceruticate uf Occupancy must be
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