HomeMy WebLinkAboutBuilding Permit #12-1219 � O ❑� C� ❑ ❑00❑ � O > yn
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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
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�•NHESO�'' 1 White File PERMIT NO. /,
?. Pink City /Z _ l L/ Y
+ Yeilow Applicam �
Ptease or rint and si at bottom
ADDRESS ZONING (uff use)
� �� �{'� � ���1� ,�-►� s �
LEGAL DESCRIPTION (oflFice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) � ���c� �" �cx.i-` �o�.e�-� (Phone) �� �- � � U� 'S3 7 �r
(Address) � ��� �-} �{ � (.Q, � �
BUII,DER ;-_ � n
(Company Name) ��C � � � �� �� (Phone) J �r� — `� y n r `J 3'7 �
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
QAddition ❑Alteration ❑Utitity Connecti n
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Conshuction: I II III IV V A B
PROJECT COST/VALUE S
Occupancy Gronp: A B E F H I M R S U (excluding land)
Division: 1 Z 3 4 5
J hereby certify that i have fumished infi�rmation un this application which is ta the best of my knowicdge true and correct. I also certffy that 1 am the owner or authorized agent fur the
above-mentioned property and that all construetion will conform ro all existing stace and locai laws and will proceed in aceordance with submitted ptans. I am aware that the buildmg
� ufficial can rrvoke thu permit Por just cause Furthermore, I hereby agree that the city official or a designee may enter upon the propetty to pcnform needed mspecnons.
X
Signature Contraecor'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 $
Penatty $ 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 Applicadon Becomes Yaur Building Perntit Whrn Approved Paid Recei t o
Date L B �
Buildine Utticiai Date
This ic to certify that the requcst in the abuvr appiicat�on and accompanying documenu u in accordance with the Ciry &>ning Ordinance and may proceed as requcsfed. This d�xument
witen sig»ed by the Ciry Planner ccrost�tut�5 a tempotary Certificate of Zoning compliance and allows construcTion tu commence. BePare �xcupancy, a CernFicate uf Occupancy must be
i.ssucd.
Planning Director Date Special CondiGons, if any
24 hour noticc for ali inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372