HomeMy WebLinkAboutBuilding Permit 12. 0245 5 0 0• n 00000 7 0 > %0
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o -pR Io1p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
( \ ' , TEMPORARY CERTIFICATE OF ZONING COMPLIANCE -I- ¢ i
U _ AND UTILITY CONNECTION PERMIT
LA NE
I. wham File PERMIT NO. l 2 , a4.5
2. Pink City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
Z 2a oo& 1) r. N,W .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID ,15, 41 . (' C Z (1)
OWNER 4 A L O d ( t� i P s-1--c, (� (Phone) YU,. - VYS V j
(Name) � Cir r rti �- � Phone
(Address) 54. A■.-0.-.. es"2- a 6e) V `e-
(Co DER 1 ' DU-C-14- [, 1) /a v - -
(Company Name) K- �t D � f C �5 01 �� U (Phone) L�
(Contact Name) UA- °'1 SeAk k'NC -re- C (Phone) )1 ` ' 2 3q1 - 7g 1 /
(Address) tU (6 0 t fJ 5T S`k (o , S o t k - kOO , A pp lS V tk i , A1 ki b E (Z --_
TYPE OF WORK ❑ New Construction eck ❑Porch ❑Re- Roofing ❑Re- Siding ��� DLower Level Finish ❑ Fireplace
DAddition ['Alteration ❑Utility Connection
CODE: 1 l I.R.C. DI.B.C. ❑ Misc:
Type of Construction: I II III IV V A B �Q 00
Occupancy Group: A B E F II I M R S U PROJECT COST /VALUE $ ?:
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. T also certify that I am the owner or authorized agent for the
above - mentioned property and that all construction will conform to all existing state and Iocal 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 city official or a designee may enter upon the property to perform needed i ectio
X ■roi. AL.4......-.. CIZ 0 0...5 7 f 3 ,, 0/ z-
+...-- Signature
Contractor's License No. Date
Permit Valuation /W-1
i e Park Support Fee # $
Permit Fee $ / - SAC # $
l�
Plan Check Fee $ &0-4( Water Meter Size 5/$ "; 1 "; $
State Surcharge $ l-- 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 eA ✓ ¢/02-. $ 1 k A sc"
This A Becomes our Building Permit en pproved Paid (� I , > Receipt No. 6 5 ict 1
Aii.or
,„ Al. ._ .
Date 41 I (Z By 1 10 VI
:uit •• a D ate
This is to . •t the request in the above application and accompanying ocu • . is is in accordance with the City Zoning Ordinance and may proceed as requested_ This document
when : r. . by e City Planner constitutes a temporary Certificate of Zoni r_ com fiance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issue. /
.r . • . - , Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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