HomeMy WebLinkAboutBuilding Permit #12-1072 g ❑❑ C� �0000 � O D zc�
n � a o o O 3� ��� m�
p C � � � � � 3 m�c = � y �,�i
M � m m y ITi N 5'z°z o y — p�
� �: '� � � - m� 0 ��� Z D
� y O Z
Q m : �-O „ -n �� N � 0 Z Z O D
� n' ; >___� Z � � O `�
o�
Z mm
� O� > Z �
� �: r p �
2 � � '9 P
� �^ � o � ❑❑❑O❑❑
'� m m m m � r ;��'�;�
� y O O nC „D.�nC
x3�mx3
� � �� m ������ m � �
� C m o ..�� y� � 3 Z m
'� a n o r�,go ��� Q° �
� � o z Z7�� z r
� z � m 1 �'°� � � v
� A � \
= m
� C A � -
y m ❑❑❑❑❑❑
'y Z � � � �1 T C1 � ` Vv �
'� y = +( y � O � m
f� 4� �m3�
o .� r �o v v -���
� z � "'� � C �- �
� n >
� m �o „ �o � � Q �'
� ��— � � N m
� �
o � PRt�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE L� � 7 ��
.. � AND UTILITY CONNECTION PERMIT •
U �
y'NNESO�r � Wh,�e Fii � PERMIT NO. i' 2,((.+ `�
x �;�G c«
; Yellow Appiicam
Please or rint and si at bottom)
ADDRESS ZONfNG (o�►'ice use�
Q g`l � 6 i ar+c� �` ►��..� j�� t� u.� ,-, �:� t�t��... Nl�Y�1 ��� z�
LEGAL DESCRIPTION (oft'ice use only)
LOT BLOCK ADDITION PID
OWNER ` ��
(Name) �it�rli�cc' (Phone) �52'Zl(� "27`l.�
(Address) � r j �$ 7 � 3[c✓� V'� C�.� � l� t�,f
BUII,DER t
(Company Name) �r'e lc1 ��G�'g ��-� (Phone) Q 5 Z� 75 $' Z 8�I Z
(Contact Name) � � v`^ � i ` (Phone)
(Address) '1C�� 1'_ c�.�r �� . `v� CJ� �'�v t�7 �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch • e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Conn io
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALIJE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hcreby certiCy that [ have fumished mfnrmation on this application which is to the best of my knowlcd�e rrue and conect. I alsu certify that 1 am thr owncr or authorizcd agcnt for the
above-mennoned pr tity and that all cunstruction will conform ro all existing state and local laws and will proceed in accordance with submitted ptans. i am aware that the buitdmg
( ufficial can rev ` s permu or just cause Furthermore, I hereby agree that the city officiai or a designee may enter upon the property to perform necded inspections.
X .��:�- r c �.s ��t� l��
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Buiider's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ .
✓
This Appiication Bernmes Your Buiiding Pem�it Whm Approved Paid Rece' No.
Date _ B
8uitdina Oftici�t Date
7'his �s to certify that thr requcst in the above applicahon and accumpanying documena is in accordance with the Ciry Z.�ining Ordinance and may proceed ac mqucsced. Thi� dixument
when signed by the City Planner cunsdtutes a temporary Certifieate of Zonmg comptianee and allows consvuction tu commence. Before �xcupancy, a Cert�6cate ��f Ocrupancy must Ix
issucd.
Planning Direator Date Special Conditions, if any
24 hour noticc for all inspections (95Z) 447-985p, fax {952) 447-424i
4646 Dakota Street Prior Lake, MN 55372