HomeMy WebLinkAboutBuilding Permit #0793 � �❑ O n ❑ ❑O❑ = O o zn
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0 � pRj �'�' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �!8 . �L
" AND UTILITY CONNECTION PERMIT
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i. wn�te F�i6 pERMIT NO. f Z�
2. Pink City
, 3. Yellow Applicant
lease e or rint and si at bottom
ADDRESS ZONING (off'ice use)
I 1 ZG�j' �vN �j wr.y� � W• �f�O� ��t�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ` �J •'
(Name) Dal� A �1/�lR (/�"�N (Phone) 91� � 334 1 0
(Address) � 7�I � 7�1� �'/� N (/( %' � .
BiJILDER ,t O
(CompanyName) r 0� (Phone) ��' TT/.� "'���
(Contact Name) (Phone) �ol Z�' 3�03 ^ 4�
(Address) �i G � �
TYPE OF WORK ❑ New Construction �Deck �Porch ❑Re-Roofing �Re-Siding ❑Lower Leve1 Finish ❑ Fireplace
❑Additioa ❑Alteration ❑Utility Conaection ���� ���.�� � �� `F )3�, f3 ��•(��
CODE: �I.R.C. ❑I.B.C. �1 Misc: � ' � �
Type of Constraction: I II III IV V A B �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ II.A'�'
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my ]mowledge true and coned. I also certify that I am the owna ar authorized agent for the
above-mentioned pro and that all truction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke ' ermit for just e. Fl�rtherruore, I hereby agree that the city of&cial or a designee may enter upon the property to paform needed insp 'ons.
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Signature Contractar's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ `� SAC # $
Plan Check Fee $ G� Water Meter Size 5/8"; 1"; $
State Surchazge $ , � 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 $ ��
Tlus Application Becomes Your Building Permit When Approved Paid Re 1 t NO.
! � �_ Date ,
�.
ildin Official Date
T7�is is to catify that the request in the above application and accompanying dacuments is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consdtutes a temparary Certificate of Zoning compliance and allows construcflon to rnmmence. Befare occupancy, a Catificate of Occupancy must be
issued.
Planning Director Date Special Conditiona, if any
24 hour notice for all inspections (9S2) 447-9830, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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