HomeMy WebLinkAboutBuilding Permit #12-1009 y ❑❑� C) ❑�❑00❑ = C o f zc?
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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
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4�NNES��� �. Wn��e File pERMIT NO.
2 Pink City � /�— /�� �
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Please or rint and si at boitom
ADDRESS ZONING (ottice use�
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LEGAL DESCRIPTION (ofl'ice use only)
LOT BLOCK ADDITION PID
OWNE�.-�-�+�
(Name) JZ7"�' �4'�'! �''1 O �9 (Phone)
(Address) j � � r s f' : � C tw ��a K � �I /� �J �
� II �!C `�lZr!' c t �c CI.s37 _ �K� (Phone) �� 7,�g ' y � .! �
(Contact Name) J 1�✓�- �t�'�KZ .c c c I�' /�r � � �� l� (Phone) �'�Z�Z'q4`� �D 9 B
(Address) � � O � f : �'/'� N�c.�- /di'�r .�tL N. D "I !
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Rddition ❑Alteration ❑Utility Connection
CODE: ❑I ❑I.B.C. ❑ Misc
Type of Construction: I II III IV Y A B pROJECT COSTIVALUE S
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 $ (excluding land)
i hereby certify that I have fumished information un this application which is ro the best uf my knowledge ttt�e and correct. [ alsu certify that 1 am the owner or author�zed agent for the
above-menuoned property and that all cunstruction will conform to ap existing state and loca! laws and wiil proceed in accordance with submitted plans. I am aware thai the buildmg
ufficial ea revuke this permit for just cause urthermore, I hereby agree that the city official or a designee may enter upon the property to pcn'form needed mspections.
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w 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 $
Pena3ty $ SewerlWater Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Depasit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLJE $
This Application Becomes Your Bwilding Pernut Whrn Approved Paid Recei O
Date B
Buiidin � Ufticial Date
This �s to certify that the request in the alwvr appiicauon and accumpanying documents u in accordance with ehe Ciry Zoning Ordinance and may protted iti requcsted. This d��cument
when signed by the Ciry Planner constitutes a temporary Certi6cate of Zonmg compliance and alluws consvuction to commence. Before �xcupanty, a Ccrhticate �>f Occupancy must be
issucd-
Planning Director Date Special Condidons, if any
24 hour notice for aif inspecrions (952) 447-9t3S0, iax (952) d47-4245
4646 Dakota Street Prior Lake, MN 55372
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