HomeMy WebLinkAboutBuilding Permit #12-1393 � ❑ q� C� O ❑ O❑ � O D N c�
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° � CITY OF PRIOR LAKE BUII,DING PERNIIT, `�t Date Rec'd
� � TEMPORARY CERTII�'ICATE OF ZONIlVG COMPLIANCE f/ Z�), �
� Z�
AND UTII.ITY CONNECTION PERMIT
d ,
NNES�
'. `�''`� �''` PERNIIT NO.
�. r;nt c�ry
� 3. Yellow AppGemt � i /
lABE OT SDd B 8L �lOtYOII! �
ADDRESS ZONIl�T(3� (o�« use)
3 r� � ��.e. ,
LEGAL DESCBIPTTON (oii'ice use only)
LOT BLOCK ADDTITON PID
OWNER �
(Name) (Phone) � �� �o� � ��� °�
(Address � � . �vl�` 7 �
BUII.�ER �� / �_ �
(Company Name) �`� (Phone) � ' 7 � `7 � � �
(Contact Name) (Phone) ��- m �.
�aaa��s� 7 � �'1'1 /If S Sd /
TY�PE OF �QB$ ❑ New Construction �Deck OPorch e-Roofing �Re-Siding ❑Lowa Levd Finish ❑ Firepla�
CJAddition ❑Alta�ation ❑Utility C 'on
CODE: [�I.B.C. �i.H.C. ❑ Misc: .
1�pe of C�ns�on: I II IQ IV V A B vo
Occo�cT Gmup: A B E F H I M 8 S U PSOJECr COSTNALUS S`� �� �� "
Dioiaio�e 1 2 3 4 S (e:clodinaLnd)�
I hereby aertity that I have fi�mished info:madon oa this application wltich is to the best of my ]mo�wledge true and coirect. I aiso afity tLAt I am the ow�ner or authoriud a�mt 8or the
above-m ' d propaty and tbat all o�stru ' will confo:m to all aosting state snd local laws and will proceed in acrordance with sabmitted plans. I am awue that the building
official rev ttiis pennit fior' cause. am , I haeby e that the city official or a drtsignee may ta upon the to pat'oim n inspec�ona.
x � G�ovC7� om ��ao fa-
S' ture Comtractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8";1 "; S
State Surcharge $ Pressure Reducer S
Penalty S Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower ee # .$
Mechanical Pen�nii Fee $ Builder's Deposit $
Sewer & Water Perrmit Fee $ Other E
Gas Fireplace Permit Fee $ TOTAL DUE $
,�'
Thie wppiicadon Becoma 7ro� snitdi� re�it when �►pproved Paid ' No.
Date i �C.r--
Buil ' Official . Date ,
This is to ce:tify that the requat in the above app8cation and aaoompanying documents is in aawrdance with the City Zoming Ordinance and may prooeed as requesoed. This docnmrnt
when si�ed by the City Planna �nstitntes a t�nporary CertiBcate of Zoning rnmpliana anfl allows constructioa to c�onoanena. Before occuPancp� a CatiScate of Occapancy mnst be
issutd.
Planning Diroctor Date Spocial Con�dona, if mry
24 hoar notkx for all inspectlona (952) 447-9860, fu (952) 447-4245
�46 Dolcota 3t�reet SE., Pr1or Lke, Minneeott 5Si72