HomeMy WebLinkAboutBuilding Permit #12-1195 y ❑❑� C� O�(❑�❑❑ = O D Nc?
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o � pR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U t�
I. Whi�e File
~ �NNeso t � z. r��► c�� PERMIT NO . ��_�� (J�'
3 Yellow Applicam
please or rittt and si at bottom)
ADDRESS ZO1�IING co���� us�>
l lo $y s�� `� rd Lc�.Ke. ��c a',1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �� � (� IAYIYI � � � � _ (Phone) / J� �, '' `1 'i T r � lDlo �
(Name) __�
(Address)
BUII.DER , ���"J� y 7��
(Company Name) '�� �`���� A'��GIt�S.4.�.� (Phone)
(Contact Name) (Phone)
(Address) �� � �. �iC�. � �G � � W 2S� ' � � �� � � �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ,, 4 Firepiace �,
❑Addition ❑Alteration ❑Utility Connection '� n `a� � ('�Q(f( C.�.f� �Y1 ��(.1 J'7����'n�
� R��i �
CODE: ❑I.R.C. ❑I.B.C._, � M ��� '
Type of Construction: I' II III IV V A B pROJECT COST/VALLTE $ a a a �
Occu an Grou A B E F H I M R S U �
p � p � ' 1 2 3 4 5 (excluding land)
Division:
1 herrby certify that 1 havr fumished mformation on this application which is tu the brst uf my knowicdge tnie and correct. f aisu certify that ! am the uwner or authonzed agent fur thc
abuve-men �onrd property and that all construction wiU conform to all rxisting s[a[e and local iaws and wiil proceed in accurdance with submittcd plans. I am aware that the buildmg
ufficial c revoke thu prr r �ust cause Furthermore, 1 hereby agree that the ciry official or a designee may enter upon the property to prrform necded inspechons.
X ��i '�C1309g3 SOC� 1 Z
Signature , Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Ivleter 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 8c Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ . 7
This Application Becomes Your Building Ferntit When AppTOVed Paid ReCei t No.
Date 0 / B
BuilJins Utiic:ial Date
Th�s �s to certify thac thc requcst in the abuve applicauon and accumpanying documents is in accordance with the Ciry Zuning Ordinance and may proceed as requcsted. This d�xument
when signed by the Ciry Planner consurotes a temporary Crrtificate uf Zoning compliance and allaws construction tu commence. Befure uccupancy, a CertiFica[c ��f Oaupancy m�st be
iaucd
Planning Director Dace Special Conditions, if any
24 hour noticc for all inspections (952) 447-98511, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372