HomeMy WebLinkAboutBuilding Permit #12-0390 S ❑❑'� C) OI�O�O❑ _ � o z�?
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oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. X AND UTILITY CONNECTION PERMIT �. Z � , � Z
U K.
ai 1. White Fife pERMIT NO
2. Pink City �� — � �
3 Yellow Applicam
Please or rint and si at bottom
ADDRESS ZONING (ott'ice use)
133(�o N � c,l�� �.e . �v �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�wr�R �; o�,r.�. �-�-�.C�In
(Phone)
(Address)
BUII,DER � {�� � � � ' _ _� � �phone �OJ -a�y � / �'�"T
(Company Name) � ��� )
(Contact Name) (Phone)
(Address) � � � � � ��'�! �• � �'N sJ � �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑R oofing � �R�e-S�ng ❑Low Level Fic sh Fireplace
❑Addition ❑Alteration ❑Uriliry Connection `�,�, (�(/� Y\� �> � J�
CODE: ❑I.R.C. ❑I.B.C. ❑ isc. � � '
Type of Constiuction: I II III IV V A B pROJECT COST/VALUE $O� I � O/�
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that [ have fumished information on this application which is to the best of my knuwlcdge true and correct. l also certify that I am che owncr or authonzcd agent for thc
abuve-mennon property and that all construttion will conform ro all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that thc buildmg
ufficial can re e this prrmit for j c se. Fwthermore, I hereby agree that the c�ty official or a designee may enter upon the properry to prrform necded inspections.
X $G I 30�I F�3 r��i�..a,1Z
Signamre Contractor's License No. Date
Permit 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 $
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This Applicatio omes Your Building Perntit When Approved Paid � Re i t NO.
Date B
G • Z l, �2�
Buil i �� Utlicial Date
Thu �s ro certify t t the requcst in the abuve applicauon and accompanying documents is in accordance with thc Ciry Zoning Ordinantt and may proceed as rcqucsted. This document
when signed by the City Planner consututes a tempurary Certificate of Zoning compliance and allows construction to commence. Befure uccupancy, a Certificate ��f Occupancy must bc
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372