HomeMy WebLinkAboutBuilding Permit 12. 0568 J
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(PR N \ \ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE '7
,� l r�, AND UTILITY CONNECTION PERMIT < . 1 Z_
+tj !` I. white File � / e ,
INNESol Z Pink City I L/> .. l PERMIT NO. t /
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I LI 2— i 1 F s t, el /411 Ai L fil'o ( Lak-f2_ 5 - ,c37z P.-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID ZS • ON Oao . .O
OWNER W f , vY> C1L✓
(Name) (Phone) 4:4 - 2-.. Z -
(Address) /
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction . eck ❑Porch ['Re-Roofing ❑Re- Siding ['Lower Level Finish El Fireplace
['Addition ['Alter i o ['Utility Connection
0
CODE: � I.R.C. ❑I.B.C ❑ Misc.
Type of C onstruction: 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 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 ha 11 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 c evoke this permi P r / , cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needep inspections. i
X F � /"
Signature Contractor's License No. Date
Permit Valuation 1,000 .00 Park Support Fee # $
Permit Fee $ '7` .--7, SAC # $
Plan Check Fee $ -4-/ ,qt Water Meter Size 5/8 "; 1 "; $
c State Surcharge $ V 0 ' 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 C? (obi, $ 12,1
, ( c
This plic. "i n Becomes Your Building Permit Whe Appro ed Paid / 2.2__. 4 Re tpt No. 67 L cis
ti ( Date Cat b P y
: uildin, iieial ll,te
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This is to ertify h the request in the above application and accompanying document s in ac rdance with the City Zoning Ordinance and may proceed as requested. This document
when sane by h City Planner constitutes a temporary Certificate of Zoning compli ce an (lows construction to commence. Before occupancy, a Certificate of Occupancy must be
issu a
■ ..1.l (Z
Pla • . • 1 ' • Da Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION
RECORD r.
SITE ADDRESS
/4211 ' L ^S1Ti�/ye. AVE.
TYPE OF WORK y..�
USE OF BUILDING it/N
PERMIT NO. L 5� .... DATE ISSUED G. �. I L
BUILDER PHONE # 41Z. 2,4Z,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT 0
INSPECTOR �
(FOOTING �`' I � � Z�(Z
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SI NED
*MOM 1 1
(FINAL I {), I � '1 - 5
3
FOR ALL INSPECTIONS (952) 447 - 9850