HomeMy WebLinkAboutBuilding Permit #12-1236 3 D O� (� O`�❑�O❑ 'o O D Zc�
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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� j f / Z
� � AND UTILITY CONNECTION PERMIT
�
�'�NHeso��' i� �'►` c�y PERMIT NO. j Z. �Z� �O
3 Yellow Applicant
Please or rint and si at bottora
ADDRESS ZONING (o� use)
l `��SSc� �-�'i� ° ` � �1�' �S3 �,2
LEGAL DESCRIPTION (of�'ice use only)
LOT BLOCK ADDITION PID
� ��� �� �a� (Phone)
(Address)
BUII.,DER r� � /�`,. ^-7
(Company Name) �� (Phone) � � ��� / — �� 1 �
(Contact Name) � ��r (Phone)
(Address) � � ��Y � ?/ ,� 7�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing e-Siding ❑Lower Levei Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Consaucrion: 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
! hcreby certiCy that [ havr fumished information on this application which is to the best uf my knowledge true and correct. I also certify that I am the owner or authonzed agcnt for the
abuve-ment�oned proprrty and that all cw iction wiil conform to atl existing state and local laws and will proceed in accordance with submittcd pians. I am aware that the buildmg
uFficial can revoke this r it for jus ereby agree that the city officia! or a designee may enter upon the propecty to perform necded mspcctions.
� x _ � �� I a—�Q� 2di 2
Signamre Contractor's Licease No. Date
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 # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ `7 -rf, '7S'�
This Application Becomes Your Building Pem�it When Approved Paid ReC t NO.
Date /Q � B •
Buildina Uttici;il Date
This �s to certify that the request in the above applicahon and accompanying documents is in accordance with the City Z�ming Ordinance and may protted ae requcsted. This document
whcro signed by the Ciry Pianner conshtutes a temporary Certificate oP Zoning comptiance and aUuws conswetinn tu commence. BePore �xeupancy a Ceruticue af Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noficc for aIi inspections (952) 447-985(i, fax (952) 4t7-4245
4646 Dakota Street Prior Lake, MN 55372