HomeMy WebLinkAboutBuilding Permit #12-1208 N O❑� C) O��O❑O '9 O D yA
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oF PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U � AND UTILITY CONNECTION PERMIT f�-1 �'�
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a��'1VES��r 1. Whi�e File � �
?. Pink City PERMIT NO
3 Yellow Applitant
Please or rint and si at bottom
ADDRESS ZONING (ottice nse�
3 g� 3 C��a�:ti.' � rc: e�°�s �i� � C-.i
LEGAL DESCRII'TION (oHfice use only)
LOT BLOCK ADDITION PID
OWNER 4 �� � [1./ l�l�l� `�
(Name) �) � � N � , (Phone) lo / Z ' � �� "7 d D ro
(Address) �$`��J ��cY3N �/Gl•�7S ��2- ��
BUII,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Consvuction ❑Deck ❑Porch �2e-Roo6ng ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Uality Connecnon
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE S��
Occupancy Group: A B E F H I M R S U
(excluding land)
Division: 1 2 3 4 5
1 hereby certify thaz I have fumished information on this apptication which is to the best of my knowicdge nve and correct. I aiso eertify thac 1 am the owner or authonzed agent for the
above-mentioned properry and thac all construction will conform ro atl existing state and local laws and will proceed in accordancr with submittcd plans. I am aware that thc buiidmg
uff'iciai c��LI(//l� e t�per � or just cause. Furthermore. I hereby agree that the ciry offcial or a designee may enter upon 2he property ro pc�'torm necd�m.� tion�
X L� 7/ o�
Signature Contractor's License No. Da e
Permit Valuation � 0� 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 Perrnit Fee $ Water Tower Fee # $
Mechanicai Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ ��
This Ap tication Becomes Your Building Pernut When Approved Paid ReCei t o.
����� /u'—!„�"`L Date — ; 1 B
Buildi�s�� Ut�icial Date
This �s ro certify that the requcst in the abuve applica[�nn and accumpanying documents is in accardance with the City Zonin� Ordinance and may proceeA as requ�seed. 7'his d�xument
when signed by the City Planner conshtutes a tempurary Certificate of Zonin� compliance and aUuws constniction tu commence. Befurr occupancy, a Ccti'aticuc oP Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc [or ati inspections (952) 447-48SQ, fax (9S2) 447-4245
464b Dakota Street Prior Lake, MN 55372