HomeMy WebLinkAboutBuilding Permit #12-364 � ❑ p� C� 0�70�00 � O D =c�
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o � rtt� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��
AND UTILITY CONNECTION PERMIT � ° �"
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y�NN68��� 1. Whire File
Z �;�, � PERMIT NO. Z 3�,
3 Yellow Applicanl
Please or rint and si at bottom
ADDRESS ZONING (ofTice use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�a�VNER ��/�� I � KOC'il � (Phone) �( 2 — u r � �/�
(Address) 7��/ ���� C'��E� �✓T / �� l�f��
BUII,DER � �� �,�+�n/ ��"r Phone `����J ��
(Company Name)_� �"� ( ) 1�
(ContactName) ��%�'/ (Phone) �lZ ���'Z6
(Address) � �C7 ��� � E.��:(�� ��C/y�L ���� .�E''(/ .. `� v d�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Firepiace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Consttuction: I II III N V A B PROJECT COST/VALUE $�7 �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I h�7eby certify that I have fi�mished mformation on this application which is to the best uf my knuwlcdge tnie and correct. I also crrtify that 1 am the uwncr or author�zed agent for the
abuve-mennoned properry and that all construction will conform to aU existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
�.ifficial can it for c ereby agree that the ciry official or a designee may enter upon the property ro perform necded msp tions.
X �'�S��p� � 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 $
This Application Becomes Your Building Pecmit When Approved Paid Re i t No.
Date . / Z.- .
Buildine Utticial Date
This �s to certify that the requcst in the abuve applicanon and accompanying documents is in accordance with the Ciry ZAming Ordinance and may proceed as requ��ted. Thrs ducument
when signed by the Ciry Planner constuutes a temporary Certificate of Zon�ng compliance and allows construction to commence. Befure uccupancy a Certiticare of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour noticc for all ins�ections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372