HomeMy WebLinkAboutBuilding Permit #12-1464 y ❑ o � c� ❑ i T � oaoa = o o N�
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p F PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
� � ♦ �n7VBS0�� � 1. White F��� PERMIT NO. � _ — � �� �t�
�,, i 2. Pink City �
3 Yellow Applicam
Picase or 'nt and s' at bottom
ADDRESS ZONING cotrice use>
�� � 1(� ,�..�-,�,�--� ��c�T ��c�.�
LEGAL DESCRIPTION (oft'ice use onty)
LOT BLOCK ADDITION PID
OWNER C � U
(Name) (Phone) .J-� 1.s� �� 7�
(Address)
BUII.DER l ( ) � ��� �
(Company Name) `' �S �'�` �' � � Phone � S �
.�
(Contact Name) 1 � (Phone)
(Address) �� �-C )-�4' S t'
TYPE OF WORK ❑ New Consvuction ❑Deck ❑Porch ❑Re-Roofing �Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addidon ❑Alteradon ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
'"` ' Type of ConstYUCtion: ' I II III N V A B ""
ccupancy Group: A B E F H I M R S U pROJECT COST/VALUE S���
' Division: 1 2 3 4 5 (excluding land)
1 hc7eby certify that ( have fumished inf�rmatioa un this apptication which is to [he best of my knowicdge true and rnrrect. t also certify tluic 1 am the owncr or wtharucd agc�nt for the
above-mennoned property and that all construction will conform ro all existing state and local laws and will proceed in accordance with submittcd plans. I am aware that the buiiding
ufficial can revyk this rmit f jusc cays Furthermore, 1 hereby agree that the city official or a desigxiee may enter upon the property to pertorm necdcd �nxpections.
``, � ' ' � 3 9�1�'�
X _
Signat�t" Contraccor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge S Pressure Reducer $
Penalty $ Sewer/Water �onnection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee � Other $
Gas Fireplace Perrnit Fee $ TOTAL DUE $ 7 C! '�
Tluis Application Becomes Your Building Permit Whrn Approved Paid �..c
(, 1�� Recei t No.
-`""`_..' Date - 7- /�-- B
` , � � _ ��.-- �,�--- _ "
Buildin � Ut�iciai Dt�te -
is to certify that thc request in the above applicauon and accumpanying ducuments is in accordance with the City Zoning Ordinance and may pracerd as requ��sted. Th�s documc�nt
��n signrd by the Ciry Planner cnast�tut�s a tempurary Certificare of Zoning comptiancc and allows constniction to commence. Before uccupancy, a Ccrtificate �1f Occupancy must be
issucd -
Planning Director Date Special'Condiuorts, if any
24 hour noticc for all inspections (9S2) 44'1-9850, fax (952) 447-4245
4646 Dakota Street Prior L�ike, MN 55372