HomeMy WebLinkAboutBuilding Permit #12-0524 � ❑❑;� C� O DO�O � O D Zc�
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� �� pRI �1P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D'��, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �
" � AND UTILITY CONNECTION PERMIT ���� — I_ <�L--.
�
j �'NES��
�. w�,��e File pERMIT NO.
2. Pink Ciry / � � ` � �
. 3. Yellow Applicant �
lease e or rint and si at bottom)
1��D�S$ g6� - 3 S'6 0. � P � ��' Z�NIN�i (office use)
LEGAL DESCR�TION (office use only)
LOT BLOCK ADDITION P�
�aW�R n e j a � C� �r J f / l S 3�c.��j Dn (Phone) 9,�2 � 2 7 g'�7�
1�
(Address)
BUII..DER
(Company Name) A II E �t �P� � -�^� • (Phone) �v�. � 20 2 63�6
(ContactName) cl vSfi�� S^��� (Phone) 763 2 a 2- 6
(Address) � 3�� �..o�c.J r'/ ��,�ict�(o 6
TYPE OF WORK ❑ New Construction [jDeck OPorch �Re-Roofing �Re-Siding �Lower Level Finish ❑ Fireplace
�Addition �Alteration ❑Utility Conn on
CODE: DI.R.C. ❑I.B.C. ❑ Misc:
Type of Constiniction: I II III IV V A B ,� S 7Y6. p�D
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ /
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished information on this application which is to the best of my knowledge true and correcc. I also certify that I am the owner or authorized agent for the
above-mentioned roperty and that all wnstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revok is permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the propeity to perform needed inspections.
x �- � BC 3 2 3 S�f� S'-so -12
Signature Contractor's License No. Date
Permit Va1 tion 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 Yovr Building Permit When Approved Paid Recei O.
Date B
$uildin Official Date
This is to certify that the request in the above applicadon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. Tlils document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to mmmence. Befare occupancy, a Certificate of Occupancy must be
issued.
Planning D'uector Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, f�x (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Mionesota 55372