HomeMy WebLinkAboutBuilding Permit #12-0101 3 O� C� ❑�.000❑ � O > ZCl
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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT Z.�, I�
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A►j I. White File
2 � ; �, � PERMIT NO. /� _/ L� /
; Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZONING (of�'ice use)
� � c°�!�✓LLt.Y, l� �llc Q
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) '1� �' �MQ n ,�' K' (Phone) �a � � O / �! S�3
(Address) / � yp 0.t� L,GZn► QQ
BUII,DER /�
(Company Name) I��o L �r� Te.� � �� �p� /�'1 � (Phone) g-�� �' 9 0 �n.S /
(Contact Name) �Q v � D �r� � CrTS' (Phone) 9S .2 a0/ ����7
(Address) 1,3 // c�'� Qw0. CT -�4i � 2 vY1 n Ss3 �8
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Con ction
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE S CD d 00•bL
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 furnished information on this application which is to the best uf my knuwledge true and correct. I also certify that ! am the uwncr ur authunud agent for thc
above-mentwned property and that all construction will conform ro all existing stare and local taws and will proceed in accordance with submitted plans. I am aware that the buildmg
ufficial can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property ro perform necded mspectiuns.
X ��.�� �,��
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 DUE $
This Application Becomes Your Building Pemut When Approved Paid R ' t No.
Date B
Buildim_ Utlicial Dnte
This �s to crrtify that thc requcst in the abuve applicauon and accompanying documents is in accordance with the City Zoning Ordinantt and may proceed as requcsted. This document
when signed by the Ciry Planner consututes a rempurary Certificate of Zoning compliance and allows construction to commence. Befure uccupancy a Certrticate uf Occupancy must be
issucd
Planning Director Dare Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, f�x (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372 �