HomeMy WebLinkAboutBuilding Permit #12-0890 ; ❑ ❑ �! c� ❑ ❑000 � o D ZA
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O F PR��� CITY OF PRIOR LAKE BUILDING PERMIT, � Date Rec'd
� t , � � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� i Z
.. • � AND UTILITY CONNECTION PERMIT
U ' � �. C�j
M��'NES��P I. White File
2. Pink ��� PERMIT NO. � Z�� �
3 Yellow Applicant
(Please e or rint and si at bottom)
ADDRESS ZONING (office use)
`�7� � (� C� m �f � i,�,:+�,�c> � �r , c � �. � 5 3��7 �
LEGAL DESCRIPTION (office use oniy) `�'
LOT BLOCK ADDITION PID
OWNER n � (� �� �r
(Name) 1'�0. Y' �`� �Gx� I�h � C--C. c'�� (Phone) fJ'� Z 3 g y y`� yU
(Address) � (� (n �'j i; �lr' i c, �-� ��l S��7Z-
BUII.,DER t�h � Q15a ' C1 �5 - `i aa.Co
(Company Name) �-�G- � C�phcx.� c�:r�d 1'�2.rcx�c�.l,tic� (Phone)
(Contact Name) �`1 Yl, _ (Phone)
(Address) �(o� �\5i�jt' 1 �- . �S tcvK '�J�J� ��o
TYPE OF WORK ❑ New Conshvction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALLTE $ � � g� i�
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify thai I have fiimished information on this application which is ro the best of my knowledge tnie and co�rect. I also certify that I am the owner or authonzcd agent for the
above-menuoned propeity and that all consmiction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
ufficial can revoke this permit for just ca se. Furthermore, I hereby agree that the ciry official or a designee may enter upon the propercy to perform necded inspections.
X��.� G�c�rasv �-�-�2-
Signature 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 $
This Application Becomes Your Building Perntit When Approved Paid Re i t No. �i �
Date �� '� B
Buildina Utticial Date
This is to certify that the request in the above application and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcstcd. This d�xument
when signed by the City Planner consututcs a temporary Certificate of Zoning compliance and allows consm�ction to commence. Before occupancy, a Ccrtificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for ali inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372