HomeMy WebLinkAboutBuilding Permit #12-1036 � O ❑� (7 O�OOO❑ � O D =A
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o � PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, r TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
V �
���'NES��� 1 Whire Pile !
� �,�, �„ PERMIT NO. f, —1 ° 3�
J Yeliow Applitant
Pleasc or rim and si at bottom)
-�" ADDRESS ZONING (oft'ice use>
3 � �,�� ��-
LEGAL DESCRIPTION {office use only}
LOT BLOCK ADDITION PID
� OWNER J �' �►�dQ- �1 (Phone) % SoZ ' ��T'S��
I
(Address) ,3 j fV �;� 1 �Q/� L—�t� �� ✓ �� 7
BUII.DER �
(Company Name)��� � �� �--�a (Phone) 7 s� ` � � 7--S-��j
(Contact Name) (Phone)
(Address) �p_. ,.u�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �te-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Firepiace
❑Addition DAlterauon ❑Utitity Connection
CODE: I.R.C. ❑I.B.C. ❑ Misc.
Type of Co ction: I II III IV V A B pROJECT COST/VALLTE S
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 havr fumished information on this appiication which is to the besi uf my knuwiedge [rue and correct. f aiso certify tha[ t am the owner or author�zed agent for the
� atwve- noned property and that all construetion wii! wnform to atl exuting state and tocal laws and will proceed in aceordance with submitted pians. I am aware that the buiidmg
� u al can evoke this permit r ju ause. rthermore, ereby agree that the city officia! or a designee may enrer upon the property to pcK�form necded mspections.
Signature Contractor's License No. Date
Permit Valuation � � f •- Park Support Fee # $
Permit Fee $ � �' SAC # $
Plan Check Fee $ Water Meter Size S/8"; 1"; $
State Surcharge $ � r- 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 p ic 'o Bernmes Your Building Permit en pproved Paid ReCei t NO. �
Date B
� � e CZ
� Bui in�+'Ut7icial �` Date
This �s to certify that the requcst in the above appiicat�on and accumpaqying documents is in accordance with the Ciry Zoning Ordinance and may proceed ac requcsted. This ducument
when signed by the Ciry Pianner consututes a temporary Certificate of Zoning compliance and aAi�ws construction to commence. Befvre ixcupancy, a Ceruticate ��f Occupancy must bc
issurd
Planning Direewr Date Special Conditions, if any
24 hour notice for att inspections (9S2} 447-98St4, fax �952) 447-�1245
4646 Dakota Street Prior Lake, MN 55372
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