HomeMy WebLinkAboutBuilding Permit #11-1068 �
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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� �� /�
.. X AND UTILITY CONNECTION PERMIT
U �rj
~��'NESO�� �. Whi�e File
2 �;�, � PERMIT NO. !' . I(� ��
3 Yellnw Applicam
Please or rint and si at bottom
ADDRESS ���' � �� / „ � ZONING (ott'ice use>
►'ll.�.� lQ� �0� �(,Z
LEGAL DESCRIPTION (oflice use only)
LOT BLOCK ADDITION PID
OWNER M / � � _ Q
(Name) ��� 1 � �C`�\l.P.� (Phone) lS� y�6 — Q.3��
(Address) "t �a � �j��.c�'fYl(.�,� �A�� C�� {—�L�(�..
BUII,DER ` / �/�^���_t �C�
(Company Name) � /- � � (Phone)
(Contact Name) (Phone)
(Address) a�� ��"�0'� � !'�Q'
TYPE OF WORK ❑.New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udlity Conne ion
CODE: ❑I.R.C. ❑I.B.C. ❑ M;sc.
Type of Construction: 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 information on this application which is ro the best of my knowlcdge true and correct. I also certify that [ am the owncr or authorized agrnt for thc
above-mennoned pr erty and that all construction will conform to all existing state and local laws and will proceed in accordance with submittcd plans. I am aware that the buildmg
� ufficial can revoke th permit f ust e Furth are, I hereby agree that the c�ty official or a designe�e may e� t�roperty to perform nec�c� s ection
X
Signature ontractor's License No. Da
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 Rec ' t No.
Date B .
Buildin � Utlicial Date
This �s to certify that thc requcst in the above applicahon and accumpanying documents is in accordance with the Ciry Zoning Ordinance an may proceed as rcqucsted. This dixument
when signed by the Ciry Plannrr consumtes a temporary Certificate of Zonmg compliance and allows construction to commence. Before uccupancy, a Cemficam 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