HomeMy WebLinkAboutBuilding Permit #12-1221 3 ❑ ❑ �- C� ❑,�1❑�O❑ � O � =c?
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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
y�HNeso'�� i. wn�:e File pERMIT NO
2. Pink City � I � • , �Z�
; Yellaw Appiicant
Ptease or rint and si at bottom)
ADDRESS ZONING (ott'ice use)
��c� 3 v - a G�Y� . �v� .
LEGAL DESC1tIPTION (office use oniy>
LOT BLOCK ADDITION PID
owxER ,/h � 1(: �
(Name) �� O�u (Phone) � �v �'" � � � — ��
(Address) � �� (7' � �/L v/ !" !�'
BiIILDER
(Company Name) � o��.�Y 5�n L.. ' (Phone) 6 �� -�.2�' ��} �q
(Contact Name) E� o• �� (Phone) �n+'^��
(Aadress) 33 I"� �c,),c, C �S I,� �� �(;c., N �'3 `12
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e•Roofing ❑Re-Siding ❑Lower Levei Finish ❑ Fireplace
❑Addition ❑Alteratiott ❑Urility Connection
CODE: �I.R.C. ❑I.B.C. ❑ Misc.
Type of ConstYUCtion: I II III N V A B C,� �QQ �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S
Division: 1 2 3 4 5
(excluding land)
! hcreby certify that [ have fumished information on this application which is to the best uf my knowledge hve and correct. f also certify that I am the owner or authonzed agent for thc
above-ment�oned property and that all cunstruction will conform to ati existing state and (ocal laws and will proceed in accordance with submitted ptans. [ am awaze that the buiidmg
ufficial can revoke this permit for �ust cause Furthennore. I hereby agree that the city official or a designee may enter upon the property to perform necded m.epcctiuns.
X ��- 8� c.� a� � 1 /� �� �' ►��
Signature Contractor s License No. Date
Permit Valuation .LS- �^, 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 # $
Mechanicai Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Firepiace Permit Fee $ TOTAL DLTE $"'t �''
This Application B es Your Building Pern�it Whea ved Paid ReCei t NO.
` Date � o , B
. /� Z •
l3uildine Ufticial Date
Thu is to certify that the requcst in the alwve appiicanan and accumpanying documents is in accordance with the City Zoning Ordinancr and may proceed ac requcsted. This d�KUment
when signed by the City Planner cunstimtes a temporary Certi6cate of Zonmg compliance and allows consauction ro commence. Befure �xeupancy, a Cea�Ficam �>f Occupancy must be
issucd.
Plsnning Direcwr Date Special Condidons, if any
24 hour noticc for ali inspections (952) 447-9850, fax (952) 447-a24i
4646 Dakota Street Prior Lake, MN 55372
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