HomeMy WebLinkAboutBuilding Permit #12-279 � ❑ ❑`� C� O ❑O�❑ � O D =A
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oF PRJp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE :�, �, <+ ; � . T
AND UTILITY CONNECTION PERMIT
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♦j �. Whice File
2. Pink �,� PERMIT NO. �`� � ���
3 Yellow Applitant
Please or rint and si at bottom
ADDRESS ZONING (ot� use)
� 6 1�P�'n.P,SS IY. S� lor�.a.Q'� rN1�l �' 7�'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /�f � �
(Name) � h r��s / ' � � I� �.° �� (Phone) � �oZ — � ad '� � �l �
(Address) L(,f �' �. � ��
BUII.,DER // � ,/
(Company Name) f�G(�k°7'awn � �/� � � (Phone) 7 � 3 ' yp7 � �' 9`�
(Contact Name) T� � 1YII���/¢��� (Phone) � ! � ' 8 �'�'�� �
(Address) Q O / k � V � �/ � /�7 � h I'U � �'O 9 �"'
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Connecti n
CODE: �I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B '� / �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $/�� ��d
Division: 1 2 3 4 5
(excluding land)
I h�reby certify that I havr fvmished mformation on this application which is to the best of my knuwicdge tnie and coRect. I alsu cenify that 1 am the uwner <>r author�zcd agent for thc
abuve-mennoned properry and at all construction will conform to ali existing state and local laws and will proceed in accordance with submitted plans. I am aware that thc buiidmg
official can revok er f just caus Furth ore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspections.
X �C b3aS3'� y— i 3 �2
Signature Conaactor'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 DUE $ . 7�
This Application Becomes Your Building Perntit Whrn Approved Paid ei t NO. �
Date Z.-
Buildim+ Utlicial Date
Th�s �s to certify that thc requcst in the above applicanon and accompanying documents is in accordance with thc Ciry Zoning Ordinance and may proceeA as rcqucstcd. Th1s documcnt
when signed by the Ciry Planner cunstitutcs a tempurary Certificaze of Zoning compliance and allows construction tu commence. Before occupancy, a Ccruficatc uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspcctions (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372