HomeMy WebLinkAboutBuilding Permit #12-1226 � ❑❑� n O�❑000 � O D Zc�
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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
`� " AND UTILITY CONNECTION PERMIT
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l. White File �
Z . P � � ;ry PERMIT NO. ���/�
3. Yellow Applicant
lease e or rint and si at bottom
ADDRE$$ ZUNING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) � -- _ . _ . . .. . (Phone) -
(Address)
BUII.,D ER )� o C�G�► � Lc7�.,�� �
(Com an Name � � ( .�( � � , -1—V l.0 (Phone) \� I � � �' � 7.0 C�
(Contact Name) ��� � �i^f � (Phone) �2 Z �R �l r" � 4 � �
(Address) a� '� S S � � / � �
TYPE OF WORK ❑ New Construction ❑Deck �Porch Re-Roofing ❑Re-Siding �Lower Level Finish ❑ Fireplace
❑Addition []Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B \
Occupancy Group: A B E F H I M R S U PROTECT COST/VALUE $ �Z �RDD ��J
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished information on this applicadon which is to the best of my ]rnowledge we and cornM. I also certify that I am the owner or authorized agent far the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke trus permit For just cause. hl�rthermore, I hereby agree that the dty official or a designee may enter upon the pmperty to perform needed inspections.
X �c �co.�o2
Signature Contractor's License No. Date
Permit Valuation Pazk Support Fee # $ -
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; i"; $
State Surchazge $ Pressure Reducer $
Penalty $ Sewer/Water Connecrion 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 Applicadon Becomes Your Bnilding Permit When Appzoved Pdid ReCei
Date B �
Buildin Official Date
This is ro certify that the request in the above application and accompanying documrnts is in accordance with the City Zoning Ordinance and may proceed as nquested. T6is documrnt
when signed by the City Planner constitutes a temporary Certificate of Zoning wmpliance and allows rnnsauction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning D'uector Date Special Conditions, if any
24 hour notice for all inspectiona (952) 447-9850, fax (932) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372