HomeMy WebLinkAboutBuilding Permit #12-0327 � ❑ ❑ � () ❑�DO�O � O D ZA
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O � PRI�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ,. � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �, � , �
.. ,,;, AND UTILITY CONNECTION PERMIT
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M�Nxeso�P I Whi[e File pERMIT NO. 3Z
2. Pink City
3 Yellow Applicant �
Please e or rint and si at bottom)
ADDRESS ZONING (ott'ice use)
l$ I��► l rno r�e At,�,� . 5, �.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
o�R 1— C 95�- �f�l�-8�
(Name) �_n r� � l� S (Phone)
(Address) s � �,>
BiJILDER
(Company Name) �'(KJUJ0�1� �U �r(��.fS�..l'� (Phone) � � �� �4� �'�
(Contact Name) (Phone)
(Address) I90�O C,O� �� " .' �S
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection C ` � 5 , n , K � C1
CODE: ❑I.R.C. ❑I.B.C.
❑ Misc. v � w� � '�r.�. c7jl
Type of Construction: I II III N V A B pROJECT COST/VALLJE $
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land) ' ,�
I hereby ceRify that I have ft�rnished infqrmation on this application which is to the best of my knowledge true and correct. I also ceitify that 1 am the owner or authonzed agent for the
above-me ioned prope�ty and all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c revoke this permit r ju cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform ded � ections.
X 6C I 309 83 O� i 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 DLTE $
This Application Becomes Your Building Pernvt When Approved Paid Re ' t No.
Date B .
Buildim� Otticial Date
This �s to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted. This document
when signed by the Ciry Planner constitutes a temporary Certificate of Zoning compliance and atl�ws construction to commence. Before �xcupancy, a Certificate of Occupancy must be
issued
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372