HomeMy WebLinkAboutBuilding Permit #12-1074 � ❑❑�3, n C1`�OODO '� O D yC�
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aF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE `� � � � �
� � AND UTILITY CONNECTION PERMIT
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"ri�, �. wn��e File pERMIT NO .
2 Pinl: City � �� ' / U �
± Yellow Applicant �
Please or rint and si at bottom
ADDRESS ZONING (ot�ice use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
� �� �,���� � -,�r'� � (Phone)
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(Address)
BUII,DER __
(Company Name) �� %�L*� �(�.�� �-- �-- (Phone} �-�Z— ��i L"3 �SZ; � ;
(Contact Name) ,�C,[��"7.� (Phone)
(Addxess) 3 L S, � �� ,2
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch -Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udlity Connection
CODB: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT CO5T/VALiTE $
Occupancy Gronp: A B E F fI I M R S U
(excluding land)
Division: 1 2 3 4 5
1 hereby certi ave Cumished information e> his application which is to the best of my knuwicdge true and corcect. [ also certify thaz ( am the owner or authi�nzed agent for thc
above-me ned � ll conform to all existing stare and local taws and will proceed in accordance with submittcd plans. I am aware that the buildmg
� ufficial re wiw►�et, Qereby agree that the city ofFcial or a designee may enter upon the properry to perform necdcd ms �ctions.
X ' ���z�� �%z
i 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 DLTE $
This Application Becomes Your Building Petmit When Approved paid ei t No.
Date i
Buiidine Ofticial Date
Thss is to certify that thc requcst in the above application and accumpanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsmd. T'h�s ducument
when signed by the Ciry Planner cnnshtutes a tempurary Cerrificate of Zonmg compliance and alluws consvuction to commence. Before �xcupancy, a CeRificate �>P Occupancy must be
icsucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S2) 447-9850, fax (952) 447-424i
4646 Dakota Street Prior Lake, MN 55372