HomeMy WebLinkAboutElectrical Permit 11.0037 � �4 PR-10.4p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
V A TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. R7Sro rite /goo 2. Pink Csh' PERMIT NO. it
3. Yellow Applicant
(Please type or print and sign at bottom) L
ADDRESS ( ZONING (office use)
31 1 2 k V0t 1:is ; Pinov: Lc kc.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ��11
(Name) P.) 1 ti ti d A o wt e-S (Phone) 9,5"‘2 2) 6 'c'c 0
(Address) r75 9 q tivIA J , . „--, OvIvf'. i Ki)C-t Pre, 07; G 5s 3 tic/
BUILDER n ` f
(Company Name) (2. ) 1.�r m r�" /� l O r^' 16 S (Phone) c f $ ? ? 9- o a �J
(Contact Name) tti vt d7 P-`t ' ' (Phone)
(Address) 1 6 c 1 . Ovket,Srer J` 0 1 - Wt. i G[k%-. 1 9(4 i vie ` 3 L ( ((
TYPE OF WORK ErNew Construction ❑Deck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ❑Utility Connection /�
CODE: ❑LR.C. ❑LB.C. ❑ mi.: 3/-Jjs et G65
Type of Construction: I II III IV V A B
1. ..7 r - �� 0 Occupancy Group: A B E F II I M R S U PROJECT COST /VALUE $ r
Division: 1 2 3 4 5 (excluding land)
T 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- mentio.e..rope and that all nstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official ca e this . mi f st se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform nee Jed inspections.
"
X C A 0423'2 e ci i!
ignature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Q Permit Fee ‘" $ SAC # $
= Plan Cheek T:r r $ 3 S ` Water Meter Size 5/8"; I"; $
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 DUE "4` -1 a, 6.0-14',....
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This Application Becomes Your Building Permit When Approved Paid jgnill_ Recei it No. rSg &1—
Date MillIMM B ;.. • ;
Building Official Date // " _ 7. / (c ,4e t (5 TC '
�
This is to certify that the request in the above application and accompanying d. eats is in accordance with the City Zoning Ordinance and may proceed as r . d. Thi . tent
when signed by the City Planner constitutes a temporary Certificate of Zoning • .mpliance and allows construction to commence. Before occupancy, a Certiti . .f Occu. ; ust be
issued. ligt
lii
Planning Director Date Special Co oon if
24 hour notice kJ all inspections (952) 447 -9850, fax (952) 447 -4245 t ` j
4646 Dnk. n Street S.E., Prior Lake, Minnesota 55372 • t D t I t ` ,5-1,(
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