HomeMy WebLinkAboutBuilding Permit #12-354 y O❑� C� 019�000 = O D Nn
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� � CITY OF PR.IOR LAKE BUILDING PERMIT, Date Rec'd
� x TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � a � �'Z�
" �' AND UTILITY CONNECTION PERMIT
e �
'LrrNN E 5 ��
,. Wh��e File pERMIT NO.
2. Pink City �� ' � �¢
3. Yellow Applicant
Please e or rint and si at bottom
� ADDRESS � ZONING (ot'fice use�
� 5 � � �-- � 1� 1`� J2.,1 I�Cz � C.I �- —
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER _ 1�('� 1•C ►� l��ti � i Phone) �5�c� �� 9 U� 7
(Name) �
(Address) S�Yh. � �J`� a— c�`y�" � 8� T
BIJII..DER
(Company Name) 7V I°g (Phone)
$ (Contact Name) (Phone)
�' (Address)
�
x;' TYPE OF WORK O New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc:
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 $
Division: 1 2 3' 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned prop and that all construction wili conform to all existing state and local laws and will proceed in accordance with submitted pians. I am aware that the building
ofl'icial can revo 't for just cause. Fur er iore, I hereby agree that the ciry official or a designee may enter upon the property to perform needed inspections.
X �- a'/a-
Signa re Contractor's License No. Date
`� Permit Valuauon Park Support Fee # $
;"} Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penaky $ Sewer/Water Connection Fee # $
�!f Plumbing Permit Fee $ Water Tower Fee # $
P'
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Applicarion Becomes Your Building Permit When Approved Paid Re i t NO. 3
Date . 3 . / Z
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Ciry Planner consatutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Condipons, if any
24 hour notice Por all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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