HomeMy WebLinkAboutBuilding Permit 11.914 Ansul System Install O 1 rRI0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,.- P-O F ZONING COMPLIANCE �� / /
,_____
AND UTILITY CONNECTION PERMIT // � i / �
y/HNesot* (A/7 ! /. i• 6 1
I. White Fik //
' PERMIT NO
2. Pink City / I 7 , 6 /
1. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
� 5 a o t O cj t ti , , sT r R t o ft_ L Pt rIC AAA s s I 2,.
LEGAL DESCRIPTION (office use only) •
LOT BLOCK ADDITION PID
OWNER 1 1 22/' C4 4.) IrvCCi S"rlz er - - (Phone)
(Address) CO 55 O go v LSy J- t /tj`t;
BUILDS 6$ (- a �j )- $ 5 S S
(Name) / uoLT l4C.aM D Fe s. A• SfC vat. .'T Y (Phone)
(Contact Name) G (LEE. VO ..,...‘J S (Phone) Gsi " a 8 7 - $SS S
(Address) CIO Lp,vE. p/{ k ED Z Ah, MN SS (oZ %
TYPE OF WORK ❑ New Construction ❑Deck DPorch DRe- Roofing ❑Re- Siding
AA)su L Sy S'in. ❑Lower Level Finish ❑ Fireplace ddition DAlteration ❑Utility Connection
NItaTA —A
tu. PROJECT COST ALUE (excluding land) S 01, T OO. r0
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or
authorized agent for the above-mentioned property and that all construction wrll conform to an existing state and local laws and will proceed in accordance with
submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the • o vial or a designee may
enter up the property to perform needed inspections. p
X _, - 1 7 l(
Si Contractor's License No. Date
Permit Valuation 3 0064 00 L Park Support Fee # $
,
Permit Fee $ g, , 2 S — L SAC # $ a
Plan Check Fee . S _. 5-7,36, , Water Meter Size 5/8';; 1 "; S
State Surcharge $ J . go Pressure Reducer $
Penalty $ i City SAC and WAC # $
Plumbing Permit Fee S Water Tower Fee # S
Mechanical Permit Fee S Builder's Deposit , $
Sewer & Water Permit Fee $ Other $
Gas Firepla (TdXJ
it Fee $ ' TOTAL DUE L 9. i , / 1 $ 0' 1 . ( l
This Your Building Permit ' 1., , 1 Paid f (l +i t No. (c 4-1.57, I, Date 7., 7.(. l t
AP At
Buillln �',.. D to
This is to certify t the request in the above application 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 construes to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any