HomeMy WebLinkAboutBuilding Permit #12-0546 g ❑ p''� n ❑�0�00 � O > Zn
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o � rtt� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT �"`�- �' ` 12-
U �
��A'NES��� I White File pERMIT NO�
2. Pink City ���',., �
i Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZOI�TING (otfice usc)
I � 2 1�u�1,�e .� .
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) � �2�"'� Cll/��" (Phone)
(Address)
BUII..DER
(Company Name) (Phone) � �Z" `'� `11 — `( 4 4! b
�
(Contact Name) (Phone)
(Address) � � � � �' � �"Z
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing -Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Conne i
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 that I have fumished information on this application which is to the best of my knowledge tnie and correct. I alsu certify that l am the uwner ur authonzed agent for the
above-mentwned propcny and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke t� cause Fu ermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspections. —
X �G`�� _
Signamre Contra or's Li ens No. Date
O
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 �"� Re 1 t NO.
Date . � , B
BuilJin � Utlicial Date
Th�s �s to certify that the request in the abuve applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceeA as requcsted. Thts document
when sigrrcd by the Ciry Planner const�tutes a remporary Certificate of Zoning compliance and allows construction to commence. Befure uccupancy, a Cernficate uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noficc for all inspections (952) 447-9850, fxx (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372