HomeMy WebLinkAboutBuilding Permit #12-0856 � O❑� (� O�OOO� 'o O D Zn
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�� PRj ��P f2' �n ��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
ti D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" � AND UTILITY CONNECTION PERMIT
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r �'N E S��
I. White File pERMIT NO .
z. p,� �,Ty 1 L- 8'`��
3. Yellow Applicant
lease e or rint and si at bottom
ADDRESS � ZONING (otnce use)
� 2 Z� [ � ��` 5 � �'�
LEGAL DESCRIPTION (ofTice use only)
LOT BLOCK ADDITION PID
owrrER < \ � � D- 6���
(Name) F ����/1 1� i'^� S (Phone) � S Z
(Address) Z Z �S U�� �� �� ( r(..� �i tit �(/ � J
BUII.,DER � � � t^/ �o� ( � � 7O ` � D ��
(Company Name) (Phone) � 5 � -
(Contact Name) �i l S G� G, �� (Phone)
(Address) 2 � l ( � �v � ' / U FJ� �� t�'�; �v � r�t. n/ ,� l D `I
TYPE OF WORK ❑ New Construction ❑Deck �Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition �Alteration �Utility Connection
CODE: ❑I.R.C. �I.B.C. �Misc: �"!�.( �S iJ�/��'OL_„6 � ��fI���U rioD�l%I
Type of Constiraction: I II III IV V A B `` � / / ��"
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ D�( cf�3-� ��
Division: 1 2 3 4 5 (excluding land) l/
I hereby certify that I have fumished information on this appfication which is to the best of my knowledge true and coirecc. I also certify that I am the owner or authmized agent for the
above-mentioned property and that all constiuction will confosm to all ezisting state and local laws and will proceed in accordance with submitted pians. I am awaze that the building
official can revok is for just cause. urthermore I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X -�- �, 3 s��' �� 7- z 7�/2
Si re 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 Permit When Approved Paid Recei t O.
Date B
Buildin official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner mnstitutes a temporary Certi6cate of Zoning mmpliance and allows construction to wmmence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Speciel Co�itions, if any
24 Lour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372