HomeMy WebLinkAboutBuilding Permit #12-0797 � ❑ ❑� C� O�.p❑�❑ � O > =c�
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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. � AND UTILITY CONNECTION PERMIT y �' j � ' � Z
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a, I White File pERMIT NO. j�, , l�
2. Pink fity
; Yellow Applicant
or rint and si at bottom)
ADDjtE$$ 3 � ZOI�TING (oFlFice use)
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LEGAL DESCRIPTION (oflE'ice use onty)
LOT BLOCK ADDITION PID
1 � � cl 6 � �' �5 ��c�.
(Name) � �- �' �hone
(Address)
B > -- , �s��, ���-?! � �
om an N ' one , �
ontact Name (Phone)
ddress ,�—� v� S
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �1Ze-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑UUliry Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Consdtuction: 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 h�7eby certify that I have fumished information un this applicatio which is tu the best of my knowlcdge true and co�rect. I also certify that I am the owncr or authorizcd agent for the
abuve-mennoned properry and that nsauction will confo t all existing stace and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can r e this permit fo t se. Furthermore, I h eb agree that the ciry official or a designee may enter upon the property to perform necded inspechons.
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Siona �rr _ ' Lice D
Permit Valuati 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 # $
Mechanicai Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Pernut When Approved Paid R ei t NO.
Date
BuilJine Ufticial Date
Th�s is to cenify that the requcst in the abuve applicanon and accumpanying documents is in accordance with the Ciry Zonin� Ordinantt and may proceeA as requcsted. This ducument
when signed by the Ciry Planner consumtes a tempurary Certificare oF Zoning compliance and aAows construction ro commence. Before uccupancy, a Certificate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, f�x (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372