HomeMy WebLinkAboutBuilding Permit #12-0517 S ❑ O� C� ❑ ❑�O❑ _ � � Z�
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oF pR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
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'�j i. White File
Z � � PERMIT NO. 1 . Z ,�- �
3 Yellow Applicant
Please or rint and si at bottom
ADDRESS // ,, ZONING (of�'ice use)
S 355 SS 't ✓ a.u.v� S�a� �✓ S� �v �f l� (►�
S� �I
LEGAL DESCRIPTION (oft'ice use only)
LOT BLOCK ADDITION PID
o�R q52 s� 5�
(Name) -p T (Phone)
(Address J v D ` ,i � �� �/� 1 � � �'-"'� � �
BUII.,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection Q � — +
CODE: .C. ❑I.B.C. �M;sc. `�F1-tt-r.-�..s � �--C^'�p�c.�-- C�c../�"T' tJ�
Type of o�nstruction: I II III IV 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 1 hav fumished inFormation on this application which is to the brst uf my knowlcdge tnie and correct. I also certify that I am the i�wner or authonzed agent for the
abuve-mennoned nd at all cunstr er�D�conform ro all existing state and local laws and will proceed in accordance with submitted plans. I am awam that the buildmg
official can revo ei it f e. Furthermore, I hereby agree that the ciry official or a designee may enter upon the properry to perform necded mspections.
X
ignature Contractor's License No. Date
Permit Valuation �'p� ,..— Park Support Fee # $
Permit Fee $ �� � SAC # $
Plan Check Fee $ ^^ Water Meter Size 5/8°; 1"; $
State Surcharge $ , p 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 ic ion es Your B ding Permit pproved Paid Recei t N
Date B
Z
Bi � Jine Ut7icial D. e
Th�s rs to ce that the uest ' the abuve applicanon and accompanying doc ent in accordance with thc Ciry Ziming Ordinantt and may prnceed u rcqucsted. Th�s document
when sign • y the iry nn consumtes a temg�ary Certificate uf Zoning c pli ce and allows construction to commence. Befure occupancy, a Ceruficate nf Occupancy must be
issucd.
Z-
Direcror Date Special Conditions, if any
ur noticc for All inspections (9S2) 447-9RS0, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS -�'3 � (� ��-N C�s Z
,� ��'4 (
TYPE OF WORK �---
USE OF BUILDING
PERMIT NO. �Z �� DATE ISSUE � � �z-
BUILDER T' �. PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FRAMING
FINAL 2
FOR ALL INSPECTIONS (952) 447-9850
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