HomeMy WebLinkAboutBuilding Permit #12-259 3 O❑� C) ���00❑ � O D Z�
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o � eR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, t TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /� ���
� X AND UTILITY CONNECTION PERMIT �� '
U �rj
~��'NES��� I. Whi�e File
2. Pink �:� PERMIT NO. �� L c�
3 Yellow Applican�
Please or rint and si at bottom)
ADDRESS ZONING (o �ce use)
� � �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER f I l �7�/'
(Name) rl l�'� f +v (Phone) ��c � �J � ^
(Address)
BUII.,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Connec ion
CODE: ❑I.R.C. ❑I.B.C. ❑ M;sc.
Type of Constiuction: I II III N 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 tha[ [ have fumished information on this application which is to the best of my knowledge true and corcect 1 alsu certify that I am the owncr or author�ud agcnt for the
above-menuoned prope� nd tha all construction will conform to ali existing state and local laws and will proceed in accordance with submitted plans. I am awam that the buildmg
otTicial can revoke t' us cause Furthe � Te, 1 reby agree that the city official or a designee may enter upon the property to perform nec�pe s.
X � Za' Z
Signa 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 DUE $ �—
This Application Becomes Your Building Pemtit When Approved Paid R i t No.
Date B
Buildim� Utlicial D�te
This �s ro certify that the requcst in the above applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinancc and may proceed as requcsted. Th�s ducument
when sigrrcd by the Ciry Planner consututes a temporary Certificate of Zoning compliance and allows construction tu commence. Befure �xcupaney, a CeruFicate uf Occupanty must be
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fex (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372