HomeMy WebLinkAboutBuilding Permit 12.0030 Platform o U OF PR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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4'1fNE I. White File
2. Pink City PERMIT NO 12 -- J
3 Yellow Applicant
(Please type or print and sign at bottom) ,
ADDRESS i ZONING (office use)
l 5 SSS P � � uh� M
LEGAL DESCRIPTION (office use only) /
LOT BLOCK ADDITION PID
OWNER 5 11 G 'tom 1 L, c P _ / (Phone) l SD - `I /
y Phone
OQ ,/ / 1 W 3�Z
(Address) 5 2 f-- 1 { 1 QL,t" S S I ✓ �L LG"1-e � ,S
BUILDER
(Company Name) 2 � ai�
�' 2
(Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck DPorch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration DUtility Connection
CODE: DI.R.C. I.B.C. ❑ ❑ Misc. t � �`�4^
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have flu. - s •d information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner or authorized agent for the
above - mentioned prop rty an t�a11 construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revo , I rmit s, ` - - .rc; T hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Sign. •re 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 Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $ ,%\ i e.....„„
Gas Fireplace Permit Fee $ TOTAL DUE $
This A /'licafon : ;comes Y .• Building Permit Whe proved Paid Receipt No.
tr Date By
r : uil 'm_ oiTZ7IT ate
This is to ce •f hat • request in the above application and accompanying do- ume is is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign'` . y e ' i ' i Planner constitutes alemporary Certificate of Zoning oma lance and allows construction to commence. Before occupancy, a Certdicatc of Occupancy must be
issued `
1 •
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
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