HomeMy WebLinkAboutBuilding Permit #12-1147 � ❑❑� C� ❑�S`{] O O❑ 'v O D Z c�
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D
oF fRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
M ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Z �� ` Z
� AND UTILITY CONNECTION PERMIT �
v �,
+�XHESO�° �. Wh��e File pERMIT NO.
2. Pink City /� ` / r ¢•
+ Yel�ow Appficant
Piease or rint and si n at bottom)
ADDRESS , � , �� �-�"( ����� �r �' " �`� ZONING (oFt use)
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LEGAL DESCRIPTION (oflFice use oniy)
LOT BLOCK ADDITION PID
� i' / l. � l I� v l W�L '�(•>' /(Phone)
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(Address)
BUII,DER r �'v -F
(Company Name) (N Y �� (Phone)
(Contact Name) (Phone)
(Address) � {�� ' � �d �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Levei Finish ❑ Fireptace
❑Addition ❑Alteration ❑Utility Conn i
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constiuction: I II ffi N V A B pROJECT COST/VALUE $ �
Occupancy Group: A B E F �i -. I M R S U (excluding land)
Division: 1 2 3 4 5
I hcreby certify that I have fumished information un this application which is to the best of my knowlcdge true and correct. t also certify that I am thr owncr or authonzed agcnt for thc
abvve-mennoned property and that all cunstruction wiil conform to ing state and local laws and will proceed in accordance with s ittcd plans. I am aware that the buitdmg
4 ufficial can revoke this perm se rthermore, agree that the city officiai or a desi nee ma� ter up� he propetty form necdcd ms •ctions.
r e`
X
i Contraccor'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 # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplaee Permit Fee $ TOTAL DUE $
Tlyis Application Secomes Your Building Pemtit Whrn Approved Paid � Re t NO.
Date • �?i- B
Buildine Utticial Date
This �s to cercify that the request in the alwve appiicahon and accumpanying dotuments is in accordance with the City Z,��ning Ordinanee and may procred ac requested. This document
when signed by the City Pianner consututes a temporary Cerri6cate of Zoning compliance and alluws construction to commence. Befure �xcupancy, a C��vticare nf Occupancy mus[ be
issucd-
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952) 447-424i
464b Dakota Street Prior Lake, MN 55372