HomeMy WebLinkAboutBuilding Permit #12-0736 � O ❑ /O� (� ❑ ❑�OO � O D ZA
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oF PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLTANCE "� G�' 1 Z
.. � AND UTILITY CONNECTION PERMIT
� �
'd►j I White File pERMIT NO. � �
2. Pink City �
3 Yellow Applicant �
Please or rint and si at bottom)
ADDRESS ZOIVING (oFlFice use)
bI�IC �� c��-c'� •✓�_
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER
� (Phone)
(Name) ��'�N � 5� � '
(Address)
BUII.,DER
(Company Name) 6Y� o � � (Phone) � �a � /�j "�� _
(Contact Name) C��-t � F ��' (Phone)
(Address) � � �j �. c 'v ✓ � /C.�i
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplam
❑Addition ❑Alteration ❑Uality Conne �
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: 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 hc7eby certify that I have fumished information on this application which is ro the best uf my knowicdge true and comect. 1 also certify that 1 am the owncr or authurized agent for the
above-menuoned property and that all construction will conform to all existing stare and local laws and will proceed in accordance with submittcd plans. I am aware that the buildmg
ufficial can revoke t' permit for just ca e. Further re, 1 hereby agree that the ciry official or a designee may enrer upon the property ro perform necded mspcctions.
X �� �� 3sro �3 7 9 /a �
Signature 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 Firepiace Permit Fee $ TOTAL DLTE � =
This Application Becomes Your Building Permit When Approved Paid ei t NO.
Date ,
.
BuiWine Ut'ticiat Date
Th�s u to certify that thc requcst in the abuve applicat�on and accumpanying documents is in accordance with the Ciry Zoning Ordinan d may pruceeA as requcsted. Th�s ducument
when signed by the City Pianner consUtutes a temporary Certificate of Zoning comp►iance and allows constn�ction to commence. Before uccupancy, a CertYficate uf Occupancy must bc
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372