HomeMy WebLinkAboutBuilding Permit #12-1296 � ❑ O� C� CT§�❑00❑ � O D yA
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�� �� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�� D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" �' AND UTILITY CONNECTION PERMIT
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�. �»�e File pERMIT NO.
2. Pink City � � � /Z� ��
3. Yellow Applicant 1 '�
lease or ' and si at bottom
�1DD�$$ � � � � � < �/' f/ t�G N � ZONING (of£ice use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDTTION PID
OWNER /� � /,,
(Name) (7� � f�S ti/"l (� [� i�� (Phone) 6 l Z'�S�l J "c v� �
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caaar�s� l �'l Z o � S� �� �,c, �v�
BUII,DER , I /� �` �
(Company Name) W#^'' 0 U�U� �j (Phone) t� S� � 7�� `
(Contact Name) �i�-�L��- (Phone)
(Address) 2 f� 2 � �` A'� �i S�G �� b _�S' �. �s..,�
TYPE OF WORK ❑ New Construction ❑Deck OPorch ❑Re-Roofing ❑Re•Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. '�Misc: � GhG� C �✓'` ��-/�ti P/.�('`J�T�-c �i(3�'►+
Type of Construcaon: I II III IV V A B � (,,(
Occnpancy Group: A B E F H I M R S U PROJECT COST/VALUE S � �� `
Division: 1 2 3 4 5 (excluding land)
I hereby oertify that I have furnished informadon on this application w}ilch is to the best of my knowiedge true and correct. I also certify that I am the owner or autltorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accardance with submitted plans. I am aware that the building
official can revoke this permit for just caus Furth ore, I hereby a�ee that the city official or a designee may enter upon the property to perform needed inspections.
X '' ��aG��6�'�l7 �� -2�'- l2
ture Contractor's License 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 # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Pernut Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ �
This Application Becomes Your Building Pernrit When Approved Paid ReCei O.
. Date B
Buildin Official Date
This is to certify that the request in the above appGcation and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows mnsuuction to commence. Before occupancy, a CertiScate of Oavpancy must be
issued.
Ptaoning Director Date Special Co�idons, if a�ry
24 hour notice for all lnspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372