HomeMy WebLinkAboutBuilding Permit #12-1168 g ❑ ❑ � (� ❑`�O�O❑ � O D ZA
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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� ¢,, �Z
.. � AND UTILITY CONNECTION PERMIT
U �
'rip I. Whi�e e�ie pERMIT NO . ^�
2. Pink CitY � (� � `/ �p �
; Yeliow Appliwm
Please or 'm and si at bottom
ADDRESS J y� t� S,l� L v e g��2 � � �Q /(7 �. � 141�-s�.. ZONING (ott�ce use�
'� 7 Z
LEGAL DESCRIPTION (of�ice use onty)
LOT BLOCK ADDITION PID
OWNER �/� / / �� /
(Name) I� .2 � C, I I� Q �-� �� �— (Phone) f? j 2 ' 4 � �( — � � S �
(Address)
BUII.,DER �
(Company Name) ����}¢e C� � r � �� V l e e `� (Phone) � � Z - �"� 1 � � b7 �
(Contact Name) �C.� � �l'�� �-�-- (Phone}
(Adcirress) � 3 C!2 C� M L � -�. 'Y � � � � � )
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition [�Alteration ❑Utiliry Con i n
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Consriuction: I II III N V A B PROJECT COST/VALUE S�/ . a�d. nC�
Occupancy Group: A B E F H I M R S U
(excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 have fumished information un this appiication which is to the best uf my knowicdge true and conect. [ also cectify that t am the owner or author�zed agent for thc
abovc-mennoned properry and that all cunstruction wiil conform to aU existing state and local laws and will proceed in accordance with submittcd pians. I am awaze that the buiidmg
ufficia! can ev ke this prrmit for use. Furthermore, I hereby agree that the ciry official or a designee may enter upon the propetty to perform necdcd incpcctions.
X I � � �3� ���3Dr !� Z
Signature Conuactor's License No. Dat
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 Firepiace Permit Fee $ TOTAL DUE $ •
This Applicarion Bernmes Your Building Pemtit When Approved Paid ` R i t NO.
Date LO> — � �
Buildin � Ufticinl Dntn
7'his �s to cr•rtify that the requcst in the atwve appticahon and accumpanyin� documents is in accordance with the Ciry 7aming Ordinance and may proceed as requcsted. This d�kument
when signed by the City Pianner cunstnutes a temporary Certificate of Zoning complianec and alh�ws construction to commence. BeFure ixcupancy, a Cerhficate uf Occupancy must be
issucd.
Planning Director Date Speciai Conditions, if any
24 bour noHcc for ail inspections (9S2) 447-9850, faz (952) 449-424i
4646 Dakota Street Prior Iake, MN 55372