HomeMy WebLinkAboutBuilding Permit #12-1413 g O❑ n ❑000 � O A ZA
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°� p R r°� CITY OF PRIOR LAI� BUII.DING PERNIIT, Date Rec' d
�� � TEMPORARY CERTII+'ICATE OF ZONING COMPLIANCE �
" AND UTILITY CONNECTZ'ON PERMIT
�
� rNNES��
'. 7. Whix File �. �
z. � a �, PERNIIT NO. /L —/5l / j I
.. 3. Yellow AppliaM
PIC88G O! 8IIa S AL bOt[Om
ADDRESS ' ZONING (o�ce use)
K�3� ,������ P�md �Z �
LEGAL DESCRIPTION (o�ce use only)
LOT BLOCK ADDTTION pID
OWNER /-
��e) (Phone) �-L�c� - . "1 7�' • �.1/ S�
cA��, � 1 lc�n: ,�� 's 7
B��
(Company Name) /,l J (1'hone) LlSI • 7� y�o��i ��
(Contact Name) (Phone)
(aaa�e�s)_ '� ' �., „�
a�rE oF waa� ❑ N� co�on �� QPot� ox� Roo
xe fing �Re-Siding QLower Level Finish ❑ Fireplaee
�Adsfition [�Altaation (�Utility Connection
CrODE: [�I.R.�. []I.B.C. �Misc: � (.N���it/t.�-bV
T�e iDf �o�ase�ocaon: I II � Iv v A B /
Occupat�c7 �roupe A$ E F H I M$ S U P80JECT COST/VpLtTE � c3 .�V� �
DiviaimM: 1 � 3 4 S (exclnding laad)' '
I hereby oa�ify that I have fiimished infoimation on this application which ia to the best of my Imawledge uue and correct. I also cadfy thst I am the awner � anthocir.ed agent for the
above-mentioaed property and that all oonstmdion will confoim to all aosting atau and local laws and w71 pmcxed in accordance with submitted plana. I am aware that du bailding
official can rev ke [his permit for just cause. Furthamon, I hueby a�ree that the city offidal or a degi�ee may eata n the piopaty to ped'orm needed inspaKions.
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� �n� � i 7�� /��� /.Z
Si�nature Contractor's License No. Date
Permit Valuation Pazk Support Fee # $
Pexm,it Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
�enalt3' $ Sewer/Wzter Connection Pee # $
Plumbing Permit Fee $ Wat�r Tqwer ee # $
l�+iechanical Permit Fee $ Builiter's Deposit $
Sewer 8c Water Permit Fee $ Other $
Gas Fireplace Peamit Fee $ TOT,AL DUE $.
9 z�
TLta wppiicatton Buoma Yom Bnitdin� re�mic when Appzoved Paid ReCEi N. 7 7
Date �. g �
Buildin Official . Date ,
This is ro cerafy ti�at the reqaest in the above appHcation aad a000mpanying documents is in nxordance with tLe qty Zoning Ordinance and ma
when signed by the C{ty Planner constiwtes a temporary Certificate of Zoning �pliaace and allows constrnctioa to commeace. Before occa y�� es requesbed. Th38 documtat
��� P��Y� a CeitiBcate of Occapancy must be
Plenning D'¢ector Dete Special Cm�dons, if �y
24 hoar notice �r nll inspecNons (9S2) 447-9850, f� (952) 447-4245
�46 Dakota Street S.E., Aior I.alcq Minnaota SSi72