HomeMy WebLinkAboutBuilding Permit #12-426 y ❑ �� C� ❑ ❑�00 = O o Nc?
n c� 2 ��� 3 � y �c0 r � m n0
p � o � � � 3 r�i �c3z-r � y �-n
tG � �' m m y ITi y �ZSZ O N p�
�° � '� "� � - Z Ii m - ���� Z �
10 v n N (� n Z Z Z�
� (Ji O
� o �O Z � _ � m�
� O � D o m
� � r � j ,
� ,� � v
� Z � n � OODOO
'� m m m m ��a'�;�
O� � y G G nC D nC
.� 2 � = ��� = W m � n
� � m � � �� _�� � o
, C� n O r�� S 7D � . C
�, � o z �SS� _ �
z ,'`�� m r �� � mv
� � �
S p
m
o � N
� N � aaaoA❑ � �
z
� o � ����� �
� s �SS�� �
� m �����
� � �
�� c
oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��,� Z
AND UTILITY CONNECTION PERMIT �
V X
�
��NNESO�� I. White File ,/") • �
Z �;�, � PERMIT NO. ! L
3 Yeilow Applicant
Please or rint and si at bottom
ADDRESS ZONING (otlFice use)
�l �1A�1 C � ��'�'�l►�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�WNER � a�,� (Phone) =,1.J� 1! '1 D�
(Address) �j �Q�� � � L
(C �1 �.� ��I "►�� � , '� li 1, (Phone) ��.��-�! l.�l�
(Contact Name) �_���L� ���. � (Phone) �1 1 �
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Con ection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. _ _
Type of Construdion: I II III IV V A B pROJECT COST/VALiTE $ I�DU
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certi'ty that I have fi�mish nformation on this application which is to the best of my knowlcdge true and correct. I also certify that 1 am the owncr or authunud agent for the
above-mennoned property and t Il consnuction will c rm to all existing state and local laws and will proceed in accordance with submittcd plans. [ am aware that thc buildmg
official can revoke this permi r st cause Furtherm ereby agree that the city official or a desi nee may enrer upon the property ro perform necded mspectiuns.
X � � 7 �� �
Signature — � r Conuactor' Li ense 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 DUE $
T
This Application Becomes Yoar Building Perntit When Approved Paid i t NO.
Date
Buildim� Utlicial Date
Th�s �s to certify that the requcst in the abuve applicauon and accompanying documents is in accordance with thc Ciry Zoning Ordinancc and may proceeA as rcqucsted. This dixument
when signed by the Ciry Planner consntutcs a temporary Certificate of Zoning compliantt and allows cunstruction to commence. Before uccupancy, a Ccrhficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for �II inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372