HomeMy WebLinkAboutBuilding Permit #11-1018 � O O� C� O�lOOO� � O D =c�
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oF pRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
� �
���'NES��� I. Whi�e File
2 �;�, � PERMIT NO. ��, l�/ �
3 Yellow Applicam
Please or rint and si at bottom
ADDI�ESS ZONING (ot�'ice use)
��� 0 � (� ov �v . ��„� � rq_; L �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�WNER ) � � � � � � � � (Phone) � � �- ` � �" ��S
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(Address) yy�3 ������� l ! ��
BLTII,DER � � � �
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Ite-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connecnolli�
CODE: ❑I.R.C. ❑I.B.C. � Misc,
Type of Cons�txuction: 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 I have fumished mformation un this application which is to the best of my knuwledge tnie and correct. 1 alsu certify that I am the owner or authurized agent for thc
abuve-mennoned property and that all conshvction ' nform ro all existing state and local laws and will proceed in accordance with submitred plans. I am aware that the buildmg
official can revoke this permit for just cause. Fu he or , 1 hereby agree that the city official or a designee may enter upon the prope[ty ro perform necded mspectii s.
X 3G /
ture 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 $�l�, 73
This Application Becomes Your Building Permit When Approved Paid Recei t NO. Z
Date B
9 3c i
Buildin � Ut7icial Date/ '
Th�s �s Yo certify that the request in thr above applicanon and accompanying documents is in accordance with thc Ciry Zoning Ordinance and may proceeA as requcsted. Th�s document
when signed by the City Planner consnmtes a tempurary Certificate of Zonmg compliance and allows canstruction ro commence. Before ixcupancy, a Ceruficate of Occupanty must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for All inspections (952) 447-9R50, fax (9S2) 44'1-4245 n
4646 Dakota Street Prior Lake, MN 55372 �a��e!'/� e��/p'���`"IOr�/��i (�
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