HomeMy WebLinkAboutBuilding Permit #12-310 S 0 O� C) O`I��OO❑ � O > =c'�
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o � PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �, ����
.. X AND UTILITY CONNECTION PERMIT
U K.
'�'NrESO�° 1 Whi�e F�� Y PERMIT NO. / 2,���
2 Pink Cit
3 Yellow Applicam �
Please or rint and si at bottom
ADDRESS ZONING (ott'ice use)
fs�l-s s� � s i��1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(I•ia � V � (� �lJ t L� (Phone)
(Address) S�
BUII,DER ` �- c�
(Company Name) � `�'T�Y'h�l�w-c�c- �'f`1-�-' (Phone) ``�Z� 2�� �`f'7
(Contact Name) ��`�-c-t '' V �. �G�tmj (Phone) ��Z -Z �j2 '��j`r��
(Address) �fti �O � �.!'�- S . �..-
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Uriliry Connectio
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALiIE �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certif'y that t have fi�mished mformation on this application which is w the brst uf my knowledge mie and correct. 1 also certify that 1 am the owner ur author�zed agent for the
abuve-menuoned pr erty and that all construction wiU conform ro all existing stare and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revok is permit for just cause. Furthermore, I hereby agree that the c�ry official or a designee may enrer upon the property to perform necded mspechons.
X Z ��y,s �-Z y- / 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 DUE $ '� ��f
This Application Becomes Your Building Pernvt When Approved Paid — R 1 t No.
Date . Z , ' I/
BuilJine Utlicial Date
This u ro certify that the requcst in the above applicanon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted. Th�s document
when signed by the City Planner consumtes a tempurary Certificate uf Zoning compliance and allows construction ro commence. Before uccupancy, a CertficaM uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9RSFl, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372