HomeMy WebLinkAboutBuilding Permit #11-0776 y ❑❑� n O�OO� _ � o N�
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oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE yy �� � I
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AND UTILITY CONNECTION PERMIT v '
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A• I. White File pERMIT NO . � ',1
2. Pink City
3 Yellow Applicant
Ptease or rint and si at bottom
ADDRESS ,ZONING (ot�'ice use)
! J� � �TJ I� �vl. ! ✓`C� /�' ( (.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUII.,DER
(Company Name) � ✓�— ✓� ,�,U-� 4 T (Phone) ��/ �. ^ a� q" O J�'''D �
/� 1 C< <' �` � `
(Contact Name) /�G t,c- ,(� �.�, f'�r,� ►�vt.4 � ✓�. � (Phone)
(Address) Q p � � w— �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Con ctio
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
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 t t 1 h ve fumished formation on this application which is ro the brst of my knowledge rrue and correct. I also ceRify that 1 am the owner or authorized agent for the
abuve-menno d pro r[y and tha Il construction will conform to all existing state and local laws and will proceed in accordance with submittcd plans. t am aware that the buildmg
official can r uke t s permit r st cause. Furthermore, 1 hereby agree that the ciry official or a designee may enter upon the p�operty to perform needed mspections.
X a��9���� � �'
Signature Contractor's License No. D e
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ 3ewer/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 $
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This Application Becomes Your Building Perntit When Approved Paid , R ei t No.
Date
Buildim+ Utticial Date
This �s to certify that thc rcqucst in thr above applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. Th�s ducument
when signed by the City Planner const�mms a temporary CertiFicate of Zoning compliance and allows construction tu commence. Before occupancy, a Cenificate uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 047-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372