HomeMy WebLinkAboutBuilding Permit #12-1191 ; ❑❑� � o -� o a y�
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o � pR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� x AND UTILITY CONNECTION PERMIT
U �
I. Whi�e File
~ �NHeso'�� z r��� c�� PERMIT NO . 1'L� %�gr'
i Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZONING corr��� �5��
3�55 5�c v c, ��ra;1 S w
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER�'� V` C.�. �'�� (Phone) �� � a a�- 3� �3
(Name)
(Address) �
BUII,DER �j� - a� y � �{ �'� T
(Company Name) �'�� ���G��u�'���,� (Phone) Sp
(Contact Name) (Phone)
(Address) �� � �. I�d• �� � � W �S't' ' � � ��e, � � �3
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑A�ddition ❑Alteration ❑Utility Connection '(�,� ���� �— (�fi �O� S U-S� � r� .Q1`f.� S��''�j
. � vr � D(�m• �`g0
CODE: ❑I.R.C. ❑I.B.C.,_ O Misc.
'� O'
Type of Constiuction: I' II III N V A B pROJECT COST/VALUE $��'= / �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: ' 1 2 3 4 5
I herrby certify that 1 havr lurnished lnformation on this application which is to the bes[ uf my knuwledge true and currrct. I alsu certify that I am the uwner or authurized agent Fur thc
above•me noned propcity and that all consa•uction wili conform to all rxisting state and local laws and will proceed in accurdance with submitted plans. I am awam that the buildmg
utl'icial revuke this per for �ust cause Fmthermore, 1 hereby agree that the c�ry official or a designee may enter upon the property ro prrform necd� In+p�uu�ti. ��
'�C13a9g3 J �a
X Contractor's License No. Date
Signature
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Nteter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLJE $ . 7
This Application Becomes Your Building Permit When Approved Paid Recei N.
Date ,2._ B '�
BuiWine U17icia� Date
This is w crrtify that thc requcst in the abuve applicauon and accumpanying documents is in accordance with thc City Zuning Ordinantt and may prc�ceeA as requcsted. This documcnt
when signed by the Ciry Planner constuutes a mmporary Certificate uF Zonmg compliantt and allows construction tu commence. Befr�re �xcupancy, a Crrt�ficate ��f Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspcctions (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372