HomeMy WebLinkAboutBuilding Permit #12-1385 3 D❑� C� ❑ ❑OO� � O D Zn
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��' �R CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" `� AND UTILITY CONNECTION PERMIT
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1. White File
2. �„� �;� PERMIT NO. �� _% �/��
3. Yellow Applicrent
Ca.4C OI alld 31 3L �)OLfOID
ADDRESS / ZONIl�TG (ofl5oe use)
J�CPa2�1 �� r� �c'lti► c. ►'C �� �S �
LEGAL DESCRIPTTON (o�'ice use oniy)
LOT BLOCK ADDITION PID L�, 3 � Z. �t� �3 �
�� ER � V e J�n � � f �� � Se' � 1 (Phone) /�� - d 3� 7 0 3
�Aa�ss� ..�C�� y�a �1��1 � yv C� i r� �t S� r� � v r��-� �e 5�37 �
BUII.DER - I + 2
(Company Name) � � � � �7 4l'Yl �; 5 E Y V i C � S (Phone) �� �- �J� � o� � � �
(Contact Name) _ �� �/_ QS G( �� (Phone) Cc' J �� lX � � `� Q 6
� i
tAd�s, �� 5 Dlcl �fr,v �3, N� w�vr�h--�n M� �5� ��
TYPE OF �VORK p New Construction pnecx �Porch e-Roofing O�-s�g Or.ow� �� F�n p F;��
pAddition �Alteration pUtility Connection
CODE: �.RC. �I.B.C. ❑ Misc:
Type of Co�cGion: I II III IV V A B c�
Occapancy Group: A B E F H I M 8 S U PROJECT COST/VALLTE S �-3 �� /' / 7
Division: 1 2 3 4 S (eaclodiag land)
I hereby oertify that I have fi�rniched iafoamation on Uti.s applicaaon wLid► is W the best of my lmowledge hue aad corrax. I ai4o oatify that I am tlie owna or authoriud a8rnt for che
above-mentioned and that all ' will confarm to ail e�osring state and loca( laws aad w�7! pmc�d in aaasdarxe with submitted plans. I am awaze that the buildiag
official can rev ' pecmit for j . Purtheimore, I hereby agree that the aty official as a desi�ee mav enter upa� the
si property to pafotm needed inspe�ons.
x u. S ` � � -� � � ` � � �/- � � oZ.
Sigqa Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # a
Plan Check Fee S Water Meter Size 5/8"; i"; $
State Surcharge S Pressur8 Reducer S
Penalty $ Sewer/Water Connection Fee # $
Plumbing Peimit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit S
Sewer & Water Permit Fee $ pther $
Gas Fireplace Pennit Fee $ TOTAL DUE $ 9��
This Appiication Becomes Yo�a Bnildi� Permic When Appu�uved Paid S � t o.
Date / 1 /L B
Buiidin Otticial I�te
This is to oaYify that 8u reqt►est m the abo�ve appdicati0n and awompanying documeats is in a000rdaace witl► the Citp Zoning Ordinaace and may pioaed as ra{uesoed. This dacu�t
wn� signea by me City Plauna � a tempo�azy Cetdficate of zoning oompliana ana allows c�uction co commen«. Eefore oo�,ipancy. a C:at�scaze oc o«,ipancy mnu ue
issued.
Ple�ming Director D� Speael Condi600s, i!'�y
24 Y�r aotiee for a� iaspectiws (952) 447-9836. tu (952) 447-41.43
4646 Dakota Stmt SE., Prior I.'ke, Mie�c� 5�372