HomeMy WebLinkAboutBuilding Permit #12-1265 3 ❑ O� C� D ❑�O❑ � O D =c�
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oF PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
�'��xeso�° 2 P oA c� Y PERMIT NO . �'L -+ � Z��
3 Yeliow Applicant
P(ease or rint and si at bottom)
ADDRESS ZONING (oE�'ice use)
� , � � � � Y� tS �. S�'` � � � �r i'vy- �-F-� � P� �� '.� �
LEGAL DE3CRIPTION (office use only)
LOT BLOCK ADDITION PID
u� OWNER � p a D -- Sa � 7
(Name) �.� � i� � r o,.,�.y ��. V cx. � e T►�. �o � r s �.� (Phone) (o S� - G
(Address) � �Q a I/eiles -�v-a.e_ 1� �- �!' izY` ��L� s����
� BUII,DER 1
(Company Name) �`t/` I � r o w r� �cx � .c r i � �o � � S�^(Phone) �2 '.� 1 - � (o D- S ot o �
(Contact Name) � � � r � -�- �S o v� so✓� (Phone) � ! � - ? � q � a � `� 3
(Address) �a � �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing ❑Re•Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration ❑Uulity Connecnon
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U pROJECT COST/VALiTE S
Division: 1 2 3 4 5
(excluding land)
i hcreby certify that i havr fumished information an this application which is to the best of my knowlcdge true and cvrrect. I aiso cectify that 1 am the owncr or authonzcd agrnt for thc
above-mennoned property and that ail consauction wiA conform to all existing state and (ocal iaws and wi(1 proceed in accordance with submitted pians. i am awaze that the buiidmg
ufficial can revoke this permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the propecty to pe�form necded inspcctions.
X
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; P'; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Perrnit Fee $ Other S
Gas Firepiace Permit Fee $ TOTAL DUE $�Q
T's i on mes Your Building Pecmit When Approved Paid Rece� t O. �
Date B
�d 2
Buil ns� Ot3icinl ate
Thfs rs to certify that the requcst in the atwve applicahon and accumpanying documents is in accordance wi[h the Ciry Zuning Ordinance and may proceed as requcsted. This ducument
when signed bq the City Planner constHUtes a temputary Certificate of Zooing complianee and allows consvuction to commence. Befure ixcupancy, a Cerutica�c uf Occupancy musc be
issued
Planning Director Date Specia! Conditions, if any
24 hour noticc for all inspections (9SZy 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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