HomeMy WebLinkAboutBuilding Permit #12-1030 y O❑� n O�❑000 = O o yc�
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D
oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �r
'yj I. Whi�e File pERMIT NO. ^
.
2. Pink City �� ,�,. � /� � �
; Yellow Applicant U
(Please e or rint and si at bottom)
ADDRESS ZOI�TING (otf�ce use)
�I`�� �+n `�rC�-e..
LEGAL DESCRIPTION (ofTice use only)
LOT BLOCK ADDITION PID
� � � � �11 t (Phone) / �� — � /Q ' Z U l� /
(Address) J 1
BUILDER u
(Company Name)�"C-'R�.W0.� R7� A'M��S21� (Phone) �lJJ � —ae�y ' / ��"�
(Contact Name) (Phone)
(Address) �Q �� C � � (�l�l p � 'e t� S � �j
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fire�jIa G�
❑Addition ❑Alteration ❑Utility Connection � � �� � � � �1(�1�� v '
CODE: ❑I.R.C. ❑I.B.C. ❑ Mis . � �
Type of Construction: I II III N V A B pROJECT COST/VALiTE $�1 ��lV- CJ�J '
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have (iimished information on this application which is to the best of my know►edge true and correct. I also certify that 1 am the owner or authonzed agent for the
abovic ennoned property t all cons[ruction will conform ro all existing state and local laws and will proceed in aceordance with submitted plans. I am aware that the buildmg
ufficia an revoke this per it for �st cause. Furthermore, I hereby agree that the ctty official or a designee may enter aport the property ro perform needcd m ections. •
X � �+' c.JV / D ✓
Signature Contractor's License No. te
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 Firepiace Permit Fee $ TOTAL DUE $ 'r , 7
This Appiication Becomes Your Building Permit When Approved Paid Recei t O L
Date B
BuilJins Utlicial Date
This �s to certify that the rcqucst in the above applicauon and acmmpanying documenu is in accordance with the Ciry Zonin�; Ordinance and may pruceed as requcsted. Thls ducument
when signed by the Ciry Planner consntutes a tempurary Certificate uf Zonmg compliance and allows construction tu commence. Before occupancy, a Cerhficate uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372