HomeMy WebLinkAboutBuilding Permit #12-1189 3 O O/'O� C� O`�O�OO � O D =A
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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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1. White F,�e pERMIT NO.
2. Pink City /�...�/ / �
3. Yellow Applicant �
ease e or rint and si at bottom
ADDRESS ZONING (ott'ice use)
��� l � G��� ��� sf ti�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER / p�
(Name) � Cw � / �C.r� ��j � �-Ln (Phone) � �Z - �b � - �J2 �p
(Address) �( G'�G Uvo G A/C (,' D r" ��� A�C� 5� � 7Z
BUII,DER (�,/tti�,i../ I.✓d��L
(Company Name) (Phone) �S ( " �� ��` �
(Contact Name) G �-Gl S�-� (Phone)
(Address)ZZ� � � I �� �VG � ,S�li l �Jd !(� S � • �.�.r/� M...V �S D
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing �Re-Siding �Lower Level Finish ❑ Fireplace
�Addition �Alteration DUtility Connection I J
CODE: DI.R.C. �I.B.C. �Misc: �/a['�/�� ✓ G✓i�lv(iS �/� T/tl3�'"�^� y/�n��f
Type of Construction: I II III IV V A B T -
Occupancy Group: A B E F H I M R S U PROJECT COST/VALiTE $ � J�
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fi�rnished information on this application wluch is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mrntioned property and that all consuuction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official can revok is permit r just cause. Furthermor I hereby agree that We ciry official or a designee may enter upon e property to perform needed inspections.
X --;- ,�3s6�`��� trs-3
Signa Contractor's License No. Date
Permit Valuarion Park Support Fee # $
Permit Fee $ SAC — # $
Plan Check Fee $ Water Meter 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 & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Bernmes Your Building Penmit When Approved Paid Recei N.
Date % 14 / B
Buildin Official Date
This is to certify that the request in the above application and acmmpanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner rnnsatutes a temporary Certificate of Zoning compliance and allows mnsauction ro commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all Inspectlons (952) 447-9850, fax (952) 447-4243
4646 Dakota Street S.E., Prlor Lake, Minnesota 55372