HomeMy WebLinkAboutBuilding Permit #11-0991 � ❑ ❑� (� ❑ OO❑O � O > ZA
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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT Q` �' ��
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'yj i. wn��e File pERMIT NO
2. Pink City
3 Yellow Applicant � / i
Please e or rint and si at bottom)
ADDRESS ZONING (of�'ice use)
Z� q 7 �s���✓� G�-,� 2r� .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
o�R � p a- y�
(Name) � � � � s � (Phone) /S / `�� � D
(Address) �p � �'/�/jf /..� � li(J '
BUII.,DER 1 S Ci °vY' 0 M��/'1 / G S
(Company Name) � � h � (Phone) / �� � � 3
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(Contact Name) I C. 2 Y (Phone)
(Address) �g(� Q • � 1s !.� � � � J ��
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Consmiction: I II III N V A B pROJECT COST/VALUE $
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 infarmation on this application which is to the best of my knowicdge tnie and correct. I alsu certify that ! am the owner or authonzed agent for the
above-mennone roperty and that all construction wiU conform to all existing stace and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revo is p�rmit fo aus i her re, 1 hereby agree that the ciry official or a designee may enter upon the property to perform necded mspection� //
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Signature ontractor's License IZ'o.7 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 DiJE $
This Application Becomes Your Building Pem�it When Approved Paid Re t NO.
Date
Buildin � Utlicial D�te
Th�s u to certify that the requcst in the above application and accumpanying documents is in accordance with the Ciry Zoning Ordinancc and may proceed as requcsted. Th�s dixument
when signed by the Ciry Planner consntutes a temporary Certificate uf Zoning compliance and allows construction tu commence. Befure uccupancy, a Cemficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fxx (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372