HomeMy WebLinkAboutBuilding Permit #12-0239 ; ❑ ❑`� c� o�aoao � o > Z�
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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
a �
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � 3��
� x AND UTILITY CONNECTION PERMIT '
U �
��NNESO�� I. White File
2 �;�, � PERMIT NO. C Z�
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZOIVING (ot�ice use)
/.�"�:.2�/ .�-'�i �QO.�►� S•�
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ��� ����4i✓ (Phone) �5�22�; _ 2,�(��
(Address)
BUII,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing Re-Siding Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑UtilityConnection �f�OQ�
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that i have fi�mished information on this application which is to the best uf my knowledge true and correct 1 also certify that [ am the owner or authonzed agent for the
above-mentioned pro}xrty and that all consauction wiU conform to all existing state and local laws and will proceed in accurdance with submitted plans. I am aware that the buildmg
official can revoke is permit for just cause. Furthermore, I hereby agree that the ciry official or a designee may enter upon the property to perform necded mspechons.
X � :� ¢3`�2
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Ptan Check Fee $ Water Meter Size 5/S"; 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 Permit When Approved Paid Cet t NO.
Date
BuilJim� Utlicial Date
Th�s u to certify that thc rcqucst in the above applicanon and accompanying documents is in accordance with the City Zoning Ordinancc and may protteA as requcsted. ThYs documcnt
when signed by the City Planner consUtutes a tempurary Cenificace of Zonmg compliantt and alluws construction to commence. Before �xcupancy, a Ceruficare uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-98Sp, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372