HomeMy WebLinkAboutBuilding Permit #13-158 oF PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � Z 5 /3
.. � AND UTILITY CONNECTION PERMIT
U �
�'tNxeso�� 2 I'in�k c� Y PERMIT NO . !3 l�
+ Yeilow Applicam
Ptease or 'nt and si at bottom)
ADDRESS ZONING (o�ice use)
! �Z�3 � � �t�/� �i �-
LEGAL DESCRIPTION (oflf'ice use oniy)
LOT BLOCK ADDITION PID
ame) �� t "�. /i �Phone) � � 7 -� G �
(Address) � 02�.�' ��--e ✓ • ��^
BUII,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Levet Finish ❑ Fireplace
❑Addition ❑Alterarion ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Construction: I u III rv V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that [ have fumished information un this application which is ro the besi of my knowledge true and conect. f aiso cectify that f am the vwner or authi�nzed agent for the
above- n oned property and tha. ali co truction w A conform ro all existing state and local laws and will proceed in accordance with submittcd pians. 1 am aware that the buildmg
� uffici 'can v e tha permtt f r Furthe re, I hereby agree that the city ofFiciai or a designee may enter upon the propeny ro perform necdcd m pections
X Z
ignatur Contractor's License No. Date
Permi aluation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Si 5/8"• I"; $
State Surcharge $ Pressure Reducer $ . O
Penalty $ Sewer/Water Connection Fee # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanicai Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ a
Tftis Applic ti Becomes Your Building Petmit Whea Approved Paid - R t NO.
Z � � �� Date S' B .
dine Ufticial Date
Thts is to ce fy that the request in the above application and accumpanying documenis is in accordance with the Ciry ZA�ning Ordina�ce and may proceed as rcqucsted. Th�s document
when signed by the Ciry Ptanner cnnshtutes a tempurary Certifieate of Zoning compliance and allows construction to commence. Befure �xcupancy, a C�7t�ficatt uf Occupancy must be
icsucd.
Planning Director Date Special Conditions, if any
24 hour natice for all inspectio�s (952) 447A85p, fax (952) 417-4245
4646 Dakota Street Prior Lake, MN 55372