HomeMy WebLinkAboutBuilding permit 13. 0385 U Q
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OF PR I_ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
v TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
v
AND UTILITY CONNECTION PERMIT - �I
4'NN ESO' 1. White File PERMIT NO .
3 Pell Applicant
/ 7 f75-- 3 Yellow Applicant f J
(Please type or print and sign at bottom)
ADDRESS / ZONING (office use)
i ' C_ 0 5 .,.,,zz2.______Z,e.,iii., A.14"
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) 8" V )WA J ■ L / { ( Phone ) ,4 /,,, ` �' OV - 81 77"
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction Deck ❑Porch DRe- Roofing DRe- Siding DLower Level Finish ❑ Fireplace
DAddition DAlter do DUtility Connection
CODE: ❑LR.C. ❑LB.C.
0 Misc. - 0 - 4 " 4/1 / 1- /A / V-- 5-7211 14----C
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H 1 M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 have punished information on this applicat , i h is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
shove- mentto yy. •-.
, ,�y� and that all construction ill nfor , II xisting state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke thi 1 it forjust c use Furt r , o , , 1 he • :r - that the city official or a designee may enter upon the property to perform needed inspect' s. ...7./j
Signature Contractor's License No. Date
Permit Valuation .""52.) (/Z) Park Support Fee # $
Permit Fee $ ',, G-x-) SAC # $
Plan Check Fee $ /(°. , -1 - Water Meter Size 5/8 "; I"; $
State Surcharge $ - 5 U 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 $ eh 7s
t 1
This Applica -, ; . ecomes Your Building Permit When Approved Paid 41,1 R ipt No. ((J f4/3 7
_ � l 7 0 Date s' -7 . ( By
Bu 0 /17,1 Official Date
This is to certify LI at 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 t! ' City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued i
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372