HomeMy WebLinkAboutBuilding Permit #12-0415 ,.
oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� �: ;� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� �<�, x AND UTILITY CONNECTION PERMIT
C.� ; ;• �
M��'NES��� 1- White File
� 2. Pink �,� PERMIT NO. �z _ ���s
/ i 'j . `� /� , ,r� i Yellow Applicam
Please e or rint and si n at bottom) �� i� y v
� ADDRESS , ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID ZJ ,( 7�f' O O� _
CC �ez oS e
�. (Na� z /�� ! ' r � (Phone) �l'�� ` � ��1
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(Address) �//� j,i
BUII.,DER
(Company Name) (Phone)
(Contact Name) (Phone)
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(Address)
� TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection /t
CODE: ❑I.R.C. ❑I.B.C. �Misc. ���4G Oi uSl G4�"�''� � r C�' R
Type of Construction: I II III IV V A B 'T S � ' c
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
(excluding land) A
Division: 1 2 3 4 5 $34� S -F '�
[ hereby certify that I h ebinf ation on this application which is to the best of my knowledge true and conect. I also certify that I am the owner or authorized agent for the
abuve-ment erty and struction will conform to all existing state and local laws and will proceed in acwrdance with submittcd plans. I am aware that the build�ng
official rev this•permu se Fuithermore, I hereby agree that the city official or a designee may enrer upon the property to perform necded inspections.
� X �'��-
Si nature 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 $ 4, _
This Application Becomes Your Building Pernrit When Approved Paid ReCel t No.
Date / /Z. B
Buildina Ofticial Date
This is to certify ffiat the request in the above applicauon and accumpanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted. This document
when signed by the Ciry Planner consntutes a temporary Certi6cate of Zoning compliance and allows construction to commence. Befure occupancy, a Ccrtificate uf Occupancy must be
issued. /1
� �� 9rJ1 I z✓WI�''ZS rCljac. "�GV a'� 2XtGYtar,srg G
Pl irector Date r J Speci Condidons, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Priar Lake, MN 55372