HomeMy WebLinkAboutBuilding Permit #12-0745 � ❑ O� C� O�Y30�❑❑ = O o Nc?
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o � PRlp CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
'I►jNNES�qP L White File pERMIT NO 'j �"'
2. Pink Ciry /L. .� /�
3 Yellow Applican�
Please e or rint and si at bottom)
ADDRESS ZONING (o�f'ice use)
l 7 / �! � G✓��-C��.���' ,�� .
LEGAL DESCRIPTION (ofiice use only)
LOT BLOCK ADDITION PID
� A rr�. L- ! /��, � (Phone)
/VC
(Address) .S�
BUII,DER �. (�.. [ � C,L(� 7� T/ 2'13 cT�-c�
(Company Name) U (Phone)
(Contact Name) _ �G�S7>/J (Phone) � ��" � � `�s�
(Address) �3 L � . S+1 'TT�3 ,/ L /�-� � L✓1) � �-4 11.�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch R oofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑[3riliry Conn ction
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 hereby cerY ' t I have ' ished informati n this app►ication which is to the best uf my knowtedge tn�e and correct. 1 also certity that I am the owner or authoryzcd agcnt for thc
abuvame one prope� a d t all cunstr ction will confotm to all exuung state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official rev e this p r rt f e urt , that the city official or a designee may enter upon the property ro prrform necded ms •ctiu .
X �35Z 3� �'i � �-
S�� � Contractor's License No. Date
rmit 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 $ 9.1
This Application Becomes Your Building Permit Whrn Approved Paid ReCei N
Date B
Buildin Ufticiai Date
Th�s �s.to certify that the requcst in the above applicauon and accompanying documents is in accordance with the Ciry Z�ming Ordinantt and may proceed as requc�ted. This d�xument
when signed by the Ciry Planner consnmtes a[emporary Certificate of Zoning compliance and allows mnstruction to commence. Before occupancy, a Ccitrficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, iax (952) 447-424i
4646 Dakota Street Prior Lake, MN 55372