HomeMy WebLinkAboutBuilding Permit #12-0916 o � rtt� CITY OF PItIOR LAKE BUILDING PERMIT, Date Rec'd
� f TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
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4'�Nxeso�° � wn��e File PERMIT NO . 1
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; Yellow Applicam
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ADDRESS �,,,) , ZONING (oti'ice usc>
�j 8 7 a b �� wd ��S \�. s� �
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
OWNER c- � �/ � �.� � /
(Name) e. ✓ � � (Phone) �-� � T � � �
(Address)
BIJILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition �Alterarion ❑Utiliry Connection
CODE: ; I.R.C. �I.B.C. ❑ Misc. �v��7�7
Type of ction: I II III N V A B pROJECT COST/VALUE $
Occupan Gronp: A B E F H I M R S U (exclnding land)
Division. 1 2 3 4 5
i hcreby certify thac I have fumished informatio on this application which is ro the best of my knowicdge true and correc[. f also certify that [ am the i�wner or authonud agent for thc
above-ment�o ed property an ait constru f n will conform to a(1 existing state and local laws and will proceed in aceordance with submittcd plans. t am aware that thc building
I ufficial can r rmit f r st re'tfi'"�Tiy agree that che city official or a designee may enter upon the propetty to perform needed mspections.
X
Signatu e Conuactor's License No. Date
Permit Valuation -Z.S� ��r Park Support Fee # $
Permit Fee $ � 4 •— SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ �� � Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Buiider's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Firepiace Permit Fee $ TOTAL DLTE $ ' Z �
T' ppli B s Your Building Permit When Ap oved Paid Recei t NO.
� Date B ,
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Bui e Dat
This is to ify tha t e request in the above appticatian and accompanying docum nu is i accordance with the City Zoning Chdinancc and may proc�ed as rcquc�sred. T'ttts document
when si b he y anner constitutes a temporary Certifieate of Zonrog co iance nd allows construction to commence. Befure �xcupancy, a Ccruticate uf Occupancy must bc
icsued �
r3 fZ
ning Directot ate Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) A47-4245
4646 Dakota Street Prior Lake, MN 55372
oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� ��-, AND UTILITY CONNECTION PERMIT
U �
4r�N�eso�° i wn��e File pERMIT NO .
2 Pink City t � �� � �
3 Yeilow Applicant
Piease or rint and si at bottom)
ADDRESS ,..) ( , ZONING (o�ice use�
�`'� 3 �5 �e��d m� r �, s, �
LEGAL DESCRIPTION (of3'ice use only)
LOT BLOCK ADDITION PID
�WNER `
(Name) � � � u � (Phone) �-��a � �'� � � � � � �
(Address}
BtJILDER
(Company Name) (Phone)
(Contact Name) (Phone}
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Levet Finish ❑ Fireplace
❑Addition ❑Alreration ❑Udiity Connection
CODE: ; I.R.C. ❑I.B.C.
❑ Misc. �� ��7�7
Type of ction: I II III N V A B PROJECT COST/VALUE S
Occupan Group: A B E F H I M R S U
(exciuding land)
Division. 1 2 3 4 5
1 hereby certiCy that i have fumished informatio on this application which is to the best of my knowiedge tnGe and comet. I also certify that ! am the owner or authorized agent for thc
aiwve-menno ed proprrty an ail constru t n wiq conform to atl existing state and local laws and wiil proceed in accordance with submittcd ptans. I am aware that the buitdmg
ufficial can r rmit f r st S ,�hat the nty officiai or a designee may enter upon the property to perform necded mspcctiims.
X
Signatu e Contractor's License No. Date
Permit Valuation -Z.S,� ��� Park Suppor[ Fee # $
Permit Fee $ , 4 � .— SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ � � � Pressure Reducer $
Penalty $ Sewer/WaCer Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DITE $ ' Z �
T" ppli B omes Your Building Perntit Whrn Ap oved Paid Recei t NO.
� Date B .
8 �3 �Z
e��� ��c
This u to ify tha t e requcs[ in the alwve application and accompanying docum nu is i accordance wi[h the City &�ning Ordinance and may proceed Lc requcsted. Th�s duaiment
when si b he anner constimtes a tempurary Certificate of Zoning co iance nd aUows construc[ion to commence. Before ixcupancy, a Ceruticate of Occupancy must be
icsucd �-
r3 rz
ning Director ate Special Conditions, if any
24 hour noticc Cor all inspections (9S2) 447-9850, f�x (9S2) 447-424i
4646 Dakota Sueet Prior Lake, MN 55372