HomeMy WebLinkAboutBuilding Permit #12-0455 y O❑� C7 ❑�f]O00 = � � y�
n �. � ° ° � ° 3 r�sc� °z � �°o m
b D a ��� 3 r 3zo Z v n �
� � m m N (Ti y �zsZ O y O�
1�0 � -Ai '-Ai � N m p �z� _�
m � n �n � � � 70
� � _7�C O A 2 n 7�C
� ,°�� n � o mm
� O � Z 70
� r o � C3
_ � � �o
� m � � � �ODOOO
'� x m m m m��'>m�
c
� � z v o �;�� m p ` n
o � � n z m
��g$ � � �
• � � �' � � �n �
� n n � �� C
�° z , m ��� � o
� � � -
x
� c A �
y °< �DOCIDO !
m
� o � C�fn�� � �
�° �
� n >m���
r �
� m ��� _ �
'� r �
oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. � AND UTILITY CONNECTION PERMIT � " � �� ! Z '"
U �
,►j I. White File pERMIT NO. ` ¢
2. Pink City � ��
3 Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZONING (of�ice use)
/GS�S !.r/� ��.�..� l��� d: f- s� {�,� � L�c N(•J
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
� � / �� .. ; ' O � � f - (Phone) G / 2� Zo� -� 3 S /
(Address) 1 �$ `'E � (� � � �� U�o � (J' S � -P,�, o i � e�
BUII.DER /
(Company Name) �3_ �o^S�'�/G7`��'► � LL� (Phone) �SZ'`�`� 7'`'��D /
"�� � Z- 3 �G� -L 2.l 8
(Contact Name) /�� (Phone) �/
(Address) � G ivo �<<v�l--a� PO �o SC z-�� Sa ✓s� M-+� 5s3 7�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �$e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connecnon
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALLTE $ l�, B�d
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I h�reby certify that 1 have fumished information on this application which is to the best uf my knuwledge true and correct. I also certify that 1 am the uwncr or authonzed agent for the
abuve-mennoned properry and t construction will conform to ali existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
ufficial can revoke is per or just ca s urthermore, I hereby agree that the c�ry official or a designee may enter upon the property ro perform necded mspections.
�CC�2 S. Z/. /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 Permit When Approved Paid R 1 t NO.
Date � •
Buildim� Utlicial Date _
This �s to certify that the requcst in the abwe applicanon and accumpanying documents is in accordance with the City Zoning Ordinance and may procerA as requcsted. Th�s d��cument
when signed by the Ciry Planner consumtes a tempurary Certificate uf Zoning compliance and allows construction to commence. Before uccupancy, a Ceruficate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372