HomeMy WebLinkAboutBuilding Permit #12-1174 � ❑ O� C� ❑��0�❑ � O D ZA
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o � pR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �j
a � ,��, �„-h,�e File pERMIT NO.
NqggO 2. Pink City ��_ "/` �
3 Yellow Applicant
ease rint and si at bottom)
ZO1�TI1�1G (ot�'ice use)
ADDRESS i
�3�� � (2L I ��
LEGAL DESCRIPTION (affice use only)
LOT BLOCK ADDITION PID
(Name) �`�/� � �/ � � � (Phone)
(Address)
BUII.,DER (` l'7!'jZ I '�/ Q ���
(Company Name) ��t� �` � �> (Phone) �
(Contact Name) � � O L'��7 (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Co ction
❑ Misc.
CODE: ❑I.R.C. ❑I.B.C• �
Type of Construction: I II III IV V A B pROJECT COST/VALiTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 have fiimished information on this application which is w the best uf my knowicdge true and correct. I also certify that I am the uwner or authunzed agent for the
above-menuoned prope�ry and that all cunstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
I official can revoke this permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspections.
X Connactor's License No. Date
Signature
Permit Valuation Park Support Fee # $ ,',�
Permit Fee $ SAC # $
Pian Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DiJE $ ,j
This Application Becomes Yonr Building Permit Whett Approved Paid _ Recei I�T . d
Date L B
" Buiidina Ufticial Date
This �s to certify that the requcst in the abuve application and accompanying documents is in accordance with the Ciry Zuning Ordinantt and may p�'oceeA as rcqucsted. This ducument
when signed by the City Planner consnrotes a temporary Certificate of Zonmg compliance and aAows construction tu commence. Before uccupancy, a Ceruficate uf Occupancy must be
issucd.
Planning Director ' Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fxx (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372