HomeMy WebLinkAboutBuilding Permit #12-1351 5 ❑❑ n ��❑❑O❑ = O o Zn
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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPOR.ARY CERTIFICATE OF ZONING COMPLIANCE l� �� j Z
.. x AND UTILITY CONNECTION PERMIT
v �
��HNESO�� 1. Whi�e File —�
� � � PERMIT NO. �Z �� /
3 Yeliow Applicant
Please or rint and si at bottom
ADDRESS ZOIVING (ott use>
/ ,
� //�-_� ��= �-� /
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �/'/
(Name) �f'ls �� 1 /i�</�1 /—' (Phone)
(Address) �
BUII.DER �q � �
(Company Name) ,�1���� G°/�"S� �U �= �l l.CJ (Phone) �� � �.f / � �
(Contact Name) � � (Phone)
(Address} � � - � � �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Firepiace
❑Addition �Alteration ❑iJdlity Conne ti
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Construction: I II III N V A B
Occupancy Groap: A B E F H I M R S U PROJECT COST/VALIJE $
Division: 1 2 3 4 5 (exciuding land)
1 hereby cert' t a have fumished information on this application which is tv the best of my know►edge rrue and conect. I atso crrtify that I am the owner or authur�ud agent for the
above-menn ned pr perty and tha[ all construetio ift •onform ro ap exisnng state and locai iaws and wiil proceed in aceordancr wich submittcd pians. I am awarc that the buildmg
ufficial can r oke is permit for en e, I hereby agree that the ciry officiai or a designee may enter upon the property to perform necded mspeMiuns.
X : �- --�� ��/ � ��`- � -��
Signature Contractor's License No. te
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 # $
Mechanicai Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE �" $ ,
This Applicatio es Your Building Perntit Whrn Approved Paid eC t NO.
' � 3 � Date /., l Z,� .
Buii ilicial Date
Thu is to certify that thc requcst in the above applicauon and accumpanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted. This document
when signrd by che Ciry Planner consntutes a tempurary Certificate of Zoning compiiance and aUuws canstruction to commence. Befure �xcupancy, a Ccrhticate �if Occupancy must be
issucd.
Planning Director Date Special Condidons, if any
24 hour notice for all inspecteons (952) 347-9RS0, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372