HomeMy WebLinkAboutBuilding Permit #12-0918 � ❑�❑ n ❑ ❑�DO 'v O D Zc�
c � � �°� � �'- 3 y >c� °O g Z ^�' �m �o
b r ° m m 7C m =r'SZpz Z � y -��
ro $ �'� - � m 0 ��� o Z O
r C� Z 0 ` Z,'0
S m D � O � ��
�
� c ?� ° - � i = � m �t
O � D o � m
� Z� d
� � � �
_ ,� � v
� z � c �
� o❑❑❑❑o
m m m m ;�v,��� , (�
� � y o o nc �nc CI )
x3�mx3 v c� cn
� c �° � � Zc=isz�czi 3 z m
b � o = r�t�� � =1 � C
0 2 � � r' '9 � � O
� A �
� ° m N �
C n � �
� y m ❑OO��O � v
� Z Z >��0� � m
R ` 0 � rvvv� �
� Z mnn5o �
� m a,mi��� �
� y �_ Z m
"� r �
��� P � CITY OF PRIOR LAKE BUILDING PERNIIT, Date Rec'd
U �� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�� AND UTILITY CONNECTION PERMIT
�
� E S��
i. wn;te F+,e pERNIIT NO. `
2. Pink City � Z�- � Y /
3. Yellow Applicant
lease or 'nt and si at bottom
ADDRESS ZONING (ot�'�ce use)
� � �'v s� — ' S�
LEGAL DESCRIPTION {oflFice use only)
LOT BLOCK ADDITION PID
owNEx � cD � e�h e.. w. /� � `1' 3�'S�
(Name) P � � ► e. o � � ( `7 'n^� � (Phone)
V�
(Address) � J � v �
BUII.,DER �
(Company Name) � C� h e..R �cz... � /�. � � (Phone) � a l a� � ( �� �
(Contact Name) � �-� (Phone)
(Address} l �J � ��( � � v � I /J ��� �J
TYPE OF W�RK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing �Re-Siding QLowa Level Finish ❑ Fireplace
❑Addition �Alteration ❑Utility Connection
CODE: �I.R.C. DI.B.C. �u�; � � � �-s- ''+� � � � � "�-�''
'I�^pe of Construction: I II III IV V A B L ' � 7
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE a� �. 7� S.
Division: 1 2 3 4 5 (excluding land)
I hereby mrtify that I have furnished informadon on this applicaaon which is to the best of my laowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all mnstruction will conform to all exisang state and local laws and will proceed in accordance with submitted plans. I azn awaze that the building
official can revoke this emut for just cause. Furthermore, I hereby agree that t6e city official or a designee may enter upon the property to perform needed inspecbons.
x �1�, G,.� �s-�-��--� Q � � 3 �. Z.� C °r � _ �I - �Z
Signature ConVactor's License No. Date
Pernut 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 DiJE $
This Application Becomes Your BuildinE Permit When Approved Paid Recei
Date / Y B
Buildin Official Date
This is to certify that the request in the above appGcadon and accompanying documents is in acwrdance with the City Zoning Ordinance and may proceed as requested. Tlris document
when signed by the City Planner cons6dttes a temporary Certificate of Zoning compliance and allows conswction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning D'uector Date Specisl Condirions, if any
Z4 hoar notice for all inspectious (952) 447-9850, fei (952) 447-4245
4646 Dakota Street S.E., Prlor Lake, Minriesota 55372