HomeMy WebLinkAboutBuilding Permit #12-246 � ❑ ❑ n ❑ ❑OO❑ � O D Zc�
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�, � C'ITY OF PRIOR LAKE BL;II.DI�G I'L:R�'TIT, Date EZec'd
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� �, "I'I�;11P()I2AIt�' C(;R'1'fFICA'I � OF 7_()\1�(� C()MVI.IANC'E
�-' "'� .�:�D UTiLITY CO:�NECT'IC)N PERMIT ���� �Z--
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� � "� `�,` PERMIT NO. �
-- P;nk ciry � � �� � �jy
3_ Sello�a� Applicant � ]�''
(Please tv e or rint and si n at bottom)
ADDRESS �s,�►, f f�it/ D/1�1�? ZONING (ot�ce use)
g�o �Qio�2 �IC N s s3�9
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) � � d � G P � [( °� �� � e � __ (Phone) 9 S a ` � � 7 _ � U 3 0
(Address) '� � �/ D S S �j � � K (M �✓ �� �7 �
BUII..DER -� � � � �
(Company Name) J�`L S �" O N ► rv,� (Phone) �Q� o� ' U� y 6 � y �
(Contact Name) .�'� S T� � S wt /k UL (Phone) � � a' y/ y"(� y y
(Address) !�L ST- � T PT ���� IN1 u �O� I
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing (�e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: �I,R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II lII IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALLTE $�d� 0��.. O U
Division: 1 2 3 4 5 (exciuding land)
I hereby certify that I have fumished information on this applicauon 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-menuoned property and that all construction will conform to all exisung state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x �N.P�J ���rnr- ��s T, ti Sw�k�l l.�c (03 s g 9y y y;�o�Z
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 $
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 DiJE $ . T
This Applicadon Becomes Your Bwilding Pernvt When Approved Paid R ei t NO. ��
Date
Buildin Official Date
This is to certify that the request in the above applicauon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Ciry Planner constitutes a temporary Certificate of Zoning compliance and allows construction to wmmence. Before occupancy, a Certificate of Occupancy must be
issued.