HomeMy WebLinkAboutBuilding Permit #12-1121 N ❑❑,� C� C�7000❑ = o o N�
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�����' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�� \ � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 2 �-� � Z J
�� AND UTILITY CONNECTION PERMIT �
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� E S ��
1. White File pERNIIT NO . Z�
2. Pink Ciry �? J � f
3. Yellow Applicant v
(Please e or rint and si at bottom
ADDRESS ZONING (o�sce use>
�qZC� �obC�-��.�1 IV1�I ��r� a 55372
LEGAL DESCRIPTION (ofiice use only)
LOT BLOCK ADDITION PID
owr�R ( �SZ - �{�S - �51
(Name) �.J�A.r O+fl �� (i � � (i( Qiir (Phone) i
(Address) Zq � o�.a � r� �,G�, � Z
BUII,DER �� Z Z Z�� D�}Z.
(Company Name) (Phone) ( p
(Contact Name) (Phone)
(Address) �2,� ^ S 2 `� r � �
TYPE OF WORK ❑ New Construction �Deck ❑Porch e-Roofing �Re-Siding OLower I,evel Finish ❑ Fireplace
�Addition ❑Alteration ❑Utility Connection
CODE:�`I.R.C. �I.B.C. ❑ Misc:
Type of Construction: I II III N V A B !�
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S � J�. �O
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fuciushed information on this application which is to the best of my lmowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will wnform to all e�sting state and local laws and will proceed in accordance with submitted plans. I am aware thaz the building
official can revo permit for just cause. Furthermar y agree that the ciry official or a designee may enter upon the property to perform needed inspectio s.
x ��.�...- C�� �' C� � �l (� � 1 R 2
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 $
Penalty $ SewerlWater 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 $
This Application Becomes Your Building Permit When Approved Paid � R i t No. Z z
D3te 6 B
Buildin Official Date
This is to certify that the request in the above applicaflon and accompanyiug documents is in accordance with the City Zoning Ordinance may proceed as requested. Tbis document
when signed by the Ciry Plam�er mnstitutes a temporary Cemificate of Zoning compliance and allows construction to mmmence. Before occupancy, a Certificate of Oavpancy must be
issued.
Plam�ing Director Date Special Conditions, if eny
24 6our notice for a11 inspections (952) 4d7-9850, f� (952) 447-4245
4646 Dakota Street S.E Prior Lake, Minnesota 55372
S Oq 1 $D
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