HomeMy WebLinkAboutBuilding Permit #12-1076 � ❑ ❑ � n O`�❑�00 � O D �c�
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,� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORA�2Y CERTIFICATE OF ZONING COMPLIANCE
� � �. ��, ��
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AND UTILITY CONNECTION PERMIT
r �'N E S��
. I. White File pERMIT NO .
2. Pink City /� � �O
� 3. Yellow Applicant
(Please e or rint and si at bottom)
ADDRESS � ZONING (ofl'ice use>
5�5�3 C�s�-� Nonz� C;,-�I�. S F
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
�aWNER �� 0 � � � Cp; � � S( N�l l/�Ol C' VI � � (Phone) L � � ` �D �a � �Q � �
(Address) J � � � S � �� V�
BIT�DER l j �
(Company Name) �� ( l� I'a �pU�i hG �' �� 1�10 I�(r�c`["I Lrl^-S (Phone) 7 � ��� �'`� �— 3 � �f y
(Contact Name) /�i�G�2., 2C�l��v�n (Phone) � � Z' �3 S'7� �Q
(Address) 7�� TO�I�/ �ri 1/� ��(� � h � 1�.) S��� �
TYPE OF WORK ❑ New Construction []Deck �Porch �e-Roofing ORe-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition DAlteration ❑Utility Connection
CODE: []I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III N V A B r� oQ
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $'�1 r ZOO�
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished informadon on this applica6on 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 construcfion will conform to all existing state and local laws and will proceed in acrnrdance with submitted plans. I am aware that the building
official can re s it f r' use. Furthermore, I hereby agree that the ciry official or a designee may entei upon the property to perfocm needed inspections.
X _ � -- . �C�;�S�� S o�f�7/Za1z
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 $ 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 $
Tlus Application Becomes Your Building Permit R'hen Approved Paid ei t NO.
Date . �
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consdtutes a temporary Certificate of Zoning compliance and allows conswction to commence. Before occvpancy, a Certificate of Occupancy must be
issued.
Planning D'vecror Date Special Contitions, if any
� 24 hour notice for all inspections (952) 4A7-9850, fax (952) 447-4245
c'') �`� �/� � 4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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