HomeMy WebLinkAboutBuilding Permit #12-0673 g ❑❑ O C� OO�OOO � O D =A
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�4 PRI��
�,� �, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT
�
r �'NES��
�. �,�,� File pERMIT NO.
2. Pink CiTy / � � �' 2
3. Yellow Applicant ���
ease or rint and si at bottom
ADDRESS � ZONING �ot��,��
/ yd 50 ��� �e 6 ,� ..� �+-„-�u, 1
r�, � � i�, �.i/ SS 3 7 a-
LEGAL DESCRIPTION (oflE'ice use only)
LOT BLOCK ADDITION PID
OWNER T � r � �
(Naxne) �-A vT � (Phone)
(Address) � QS � /k c b,'..- e /'• ��' r� n� s S 3� a
BUII.,DER �"!� s� ✓1 G= �2r^ � ✓ 6 � � " `� � / - s a a i
(Company Name) (Phone)
(Contact Name) I Q �"'� � < < '� (Phone)
(Address) . Q U � �� e /' • � V Ss4
TYPE OF WORK ❑ New Construction ❑Deck OPorch �te-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition DAlteration ❑Utility Connection
CODE: ❑I.R.C. DI.B.C. ❑ Misc:
Typc of Construction: I II III IV V A B G �
Occnpancy Group: A B E F H I M R S U PROJECT COST/VALUE $ /� ��� �
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on Uils application w6ich is to the best of my knowledge hue and correct. I also certify that I azn the owner or authorized ageat for the
above-mentioned property and that all construction vrill con4orm to all existing state and local laws and will proceed in acmrdance with submitted plans. I am aware that the building
official can revoke ' permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspations.
X r�C �3� 3/ � �- a-2-1�-
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ � 9 p 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 $ . 7�
This Application Becomes Your Building Permit When Approved Paid ReCei t NO
Date B
Buildin Official Date
Ti�is is to certify that the request in the above applicadon and accompanying dncuments is in accordance with the City Zoning Ordinance and may proceed as requeaoed. This documrnt
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows rnnstruction to rnmmence. Before occupancy, a Certificate of Occupaacy must be
issued.
Planning Director Date Special Conditions, if aay
24 6our noHce for all iospections (952) 447-9850, faa (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 53372