HomeMy WebLinkAboutBuilding Permit #12-1166 � ❑ ❑� C� O ❑�00 � O D =c�
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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� 3 � L
� � AND UTILITY CONNECTION PERMIT
~�n'NES��� �. whi�e File
Z �;�, C„ PERMIT NO. !� `� ��
3 Yellow Applitam �
Please or rint and si at bottom
ADDRESS ZONING (otnce use�
1�0
LEGAL DESCRIPTION (otlFice use only)
LOT BLOCK ADDITION PID
OWNER (~� n
(Name) ���� � 1 �-�.� /Z�S (Phone) '7 �Z "" �l O - 9s'�r
(Address) �G10 � � ./`'t C'�c� r`� !" �Q � �
BUII,DER '�.3 �� � t(o�o �
(Company Name) �/N� Cx�s or`S (Phone) ________— ____
(Contact Name) � � �O 2�c`�'� (Phone) �! Z S 9� �O �'i
(Address) ��✓ /S•t— c>L � •t�� S 53
TYPE OF WORK ❑ New Consiruction ❑Deck ❑Porch �e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition []Alteradon �Utility Conn ion
CODE: �I.R.C. �I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B �' 3Z� °�'
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ i
Division: 1 2 3 4 S
(excluding land)
1 hereby certiCy that [ have fumished information on thu appticatiun which is ro the best of my knowicdge true and correct I also certify that I am the owncr or authonzcd agcnt for the
above-ment4oned property and that all construction wili conform tn aU existing state and local laws and will proceed in accordance with submitted plans. I am awam that the buildmg
otl'icial can revoke this permit for just cause. Furthermore, I hereby agree that Che c�ry officiai or a designee may rnter upon the property to pecform necded mspcctions.
x �J�_---° �`- �� '�� �3 � 088 !o - 3- t 2
ignature 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 $
Penaity $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanicai Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other �
Gas Fireplace Perrnit Fee $ TOTAL DUE $
This Application Becomes Your Buiiding Pe►mit Whrn Approved Paid R i t No.
Date 6. 3 /
8uildin � Uf1icial D1te
This u ro cemfy that thc requcst in the above appiicauon and accumpanying documents is in accordance with the City Zonin� Ordinancc and may proceeQ as requ��etcd. 7'his dexumcnt
when signed by the City PLinner consntutes a tem{wrary Certificate uf Zoning compliance and allows consvuction to commence. Before �xcupancy, a C�tihtieare of Occupancy must bc
issucd.
Planning Director Date Special Conditlons, if any
24 hour noticc tor all inspections (952) d47-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372