HomeMy WebLinkAboutBuilding Permit #12-297 N O❑� C� O�Of]0❑ = O 0 yn
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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.�'. X AND UTILITY CONNECTION PERMIT
U �
���'NES��� I. White File
Z �;n, �;, PERMIT NO. �Z �9 7
3 Yellow Applicant
Please or rint and si at bottom
ADDRESS ZONING (ot�ice use)
� l..P � � � c�� lo r' �. �r . �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
owivER � �n r,�2-�-� ��e�' t^ ,� 5 2- 3 9 3- 0�3 �1 �
(Name) � 1^ t 0.Y1 °� t (Phone
(Address) �,p Q �"jY' � C, � �, f` i Ov L�J�.
BUII.,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addipon ❑Alteration ❑Utility Conne ti n
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Consttuction: I II III IV 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
I hereby certify that f have fumished mformation on this application which is w the brst uf my knowledge true and correct. 1 also certify that 1 am the owner or authonzed agent for the
abuve-mennone pe�ty and that all consauction will conform ro ali exuting state and local laws and will proceed in accordance with submittcd plans. I am awam that the buildmg
official can oke t s it for �ust cause. Fu�thermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspections.
X � � �- I�d� ZOIZ
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 $
This Application Becomes Yow Building Permit Whrn Approved Paid Recei t N
Date B '
BuilJin � Utlicial Date
This �s to certify that thc requcst in the abuve applicanon and accumpanying documents is in accordance with thc Ciry Zoning Ordinance and may proceed as requcstcd. This document
when signed by the City Planner constimtcs a temporary Certificate of Zoning compliance and aAows consm�ction to commence. Before occupancy, a Cert�ficate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fex (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372