HomeMy WebLinkAboutBuilding Permit 11. 0256 5 ❑ ❑ 13 0 ❑❑ ❑O❑❑ -a O > E
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Apr 14 11 02:53p AMERICAN RESIDENTIAL SERV 6122210349 �1 p,1
O* PR .to C.
/�f CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
4 II `' l TEMPORARY MP CERTIFICATE OF ZONING COMPLIANCE /
' I '' \ AND UTILITY CONNECTION PERMIT ¢ /.1, //
I A•FS°
1 Wm* File �
2 pink City PERMIT NO. / / a -7
J1O
3. Yellow Applirnre / 1
(Please type orllrint an_ d sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION P11)
OWNER
(Name) ELm6X C Lid 4' f _ Jai...? .G.? it.1 ' G2.. 4 , 4 (Phone) ' s '`/4 7 L?-
(Address) ! If.,d VE
BUILDER
(Company Name) ! G/t..ri ..__....!i. °.a�1'1 10 7`.1/1/. S ►'Y S (P hone) ( 35.2 " ?'' 5'6°7`'I OA
(Contact Name) If CAT? (Phone) A 2._; i' 6,74f 9
(Address) s-14, 4 t___.G� 7 Y2..., . S 31' ? S
TYPE OF WORK ❑ New Construction 017eck ❑Porch ryi• e- Roofing ❑ke.Siding [:1 Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑utility Conn 'o.
CODE: DI.R.C. DLB.C, ❑ Mist':
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ rf (0 ` y b
Division: 1 2 3 4 5 _.._ (excluding land)
I hereby certify that !have furnished information on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above - mentioned property and that all 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 e hi for just cause. Furthermore, I hereby arce that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Y Date
Permit Valuation Park Support Fee # $ Permit Fee $ SAC #t $
Plan Check Fee - $ W
ater Meter Size 5i8 "; 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 i $ Other $
Gas Fireplace Permit Fee S TOTAL DUE '15
This Application Becomes Your Building Permit When Approved Paid - / 7.5 [ec ' t No. 42...5'.4-7
Date 4. !.5 , // ! By
Building0 Date
This is to certify that 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 mnstinwes a temporary Certificate of Zoning compliance and allows construction to commence. Define octurparicy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952)447 -9850, fax (952) 447 -4245
4646 Dakota Street S.F „, Prior Lake, Minnesota 55372