HomeMy WebLinkAboutBuilding Permit #12-0839 S O❑ O C� O ❑00 � O D NA
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oF PR�O� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
c� �,
��4'NES��Ct' i wn��e F�ie PERMIT NO. /Z � g �
2. Pink City
3 Yetlow ApQlicaM / �
Piease or rint and si at bottom
ADDRESS ZONING (ott use>
� y f�"� /,,�����... C'� .SC /''��� �.,�-�� ��
LEGAL DESCRIPTION (ot�'ice use only)
LOT BLOCK ADDITION PID
OWNER / / /�/
(Name)
�Gl�.h � �G �( � � �� (Phone) CY[ 2 � ' �G� " �'`r��
(Addzess) �3 ��OeY (G2-k t �l�— ..�C' ����llL
(�p ) �'e!� � �C2��1� ���
Com an Name _S (Phone �
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Levei Finish ❑ Fireplace
�Addition �Alterarion ❑Utitity Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/ VALUE S
Occupancy Group: A B E F H I M R S U
(excluding land)
Division: 1 2 3 4 5
I hereby certi fu ' d information un this application which is ro the best uf my knowledge true and conect. t atso cectify tha[ I am the owner or authorized agent for thc
above- ned pe d t all cu � tion will conform ro ali exuting state and local laws and wili proceed in accordance with submitted ptans. I am aware that the buiidmg
uFfi ' can re e this o ca urthe � ore, I hereby ag ree that the city officiai or a designee cnay enter upon the propecty to perform necdcd u�sprctions.
7 .2 �- �' 2
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Ptan Check Fee $ Water Meter Size 5/8"; I"; $
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 Appiication Becomes Your Building Pern�i�t When Approved Paid Recei
Date B
Buildins Ufticial Date
Thrs �s to certify that the requcst in the above applicanan and accompanying documenis is in accordance with che Ciry Zoning Ordinance and may pmtted �.c requcsteQ. Th�s document
when signed by the City Planner constimtes a temporary Certificate uf Zoning compliance and alluws constructi�n to commence. Befure ixcupancy, a C�7uficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2} 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372