HomeMy WebLinkAboutBuilding Permit #12-1187 S ❑ O� C� ❑ ❑❑❑O � O D Zc�
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� PRIO �
,�� �' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� AND UTILITY CONNECTION PERMIT
�
j �'N E S��
,. Wh�� File PERMIT NO. L_ �/
. . 2. Pink City
. 3. Yellow Applicant
lease e or rint and si at bottom
ADDRESS � � � Z,,� � � � � � �--�-,�..� `\ S � ZONING (oflf'ice use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITIQN PID
OWNER ('�
(Name) �� � Lcr'� v: �( (Phone) � i a - � g � - � g �
(Address)
,B�B�R�a�•�cG o�/
(Company Name) l.c KQ �-Y� sf� ��-' ..-�.,�.� rc (Phone) �S.Z gScP—SS S't'S
(Contact Name) (Phone) �C� 3 �-$ — � 5 �o�
(Address) ,� S �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �te-Roofing ❑Re-Siding �Lower Level Finish ❑ Fireplace
�Addirion �Alteradon �Utility Connection
� CODE: �I.R.C. �I.B.C. ❑ Misc:
Type of Construction: I II III N V A B o�'
� Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S �S�a �
' Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished informadon on this appflcadon whieh is ro the best of my knowledge true and cottect. I also certify that I am the owner or authorized agent for the
above-mrntioned pmperty and that all construction 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 revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may rnter upon the property to perfo:m needed inspecti ns.
X �. .o �C �� 3b� � r� 8
Signature Contractor's License No. ate
Permit Valuation 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 Pertnit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ , 7
17ils Applicarion Becomes Your Bnilding Permit When Approved Paid Recei N.
Date Z-- B
Buildin Official Date
This is to certify that the request in the above applicadon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consamtes a temporary C�cate of Zoning compliance and allows consauction to commence. Before occupancy, a Certi6cate of Occupancy must be
issued.
Planning Director Date Spwial Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372