HomeMy WebLinkAboutBuilding Permit 12. 0632 VOID (4
PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / /(� /
.. AND UTILITY CONNECTION PERMIT (G
U t
�. I. while File A I c)
/P►'NE Pink al PERMIT N
10 - (3U 6/- 3 Yellow Applicant
(Please type or print and sign at bottom) �J
ADDRESS 5 -1M
"s, 4vi- ZONING (office use)
j
1 �- B a O ► ► 1 - - A L/ , ?f' AI t MN 1 - 9 - 3 1 q
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) -1 U ( ft p .re V (Phone) 95 J 3 75
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction Deck EPorch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
['Addition ❑Alter to ['Utility Connection
CODE: C. ❑I.B.C. ❑ Misc.
Type of nstruction: I II III IV V PROJECT COST /VALUE $
Occupancy Group: A B E F HI M R S U (excluding land)
Division: 1 2 3 4 5
1 1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner or authorized agent for the
above- mentioned ,propcity an 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 r. vo • this .,, - • for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ''itg. AA 6 ' 1 " / Z
Signature Contractor's License No.
Date
Permit Valuation 4 Qo Q 0 0 Park Support Fee # $
Permit Fee $ ' /03_ 00 SAC # $
Plan Check Fee $ P f ? _ / / 0 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Ys' le -•� Pressure Reducer $
Penalty $ Lr V 1. 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 I $ TOTAL DUE eitxt ( i 1Z_ $ / 7 / . 75
4 .
Thi 1 a y B ecomes lour Building Perini en • .proved Paid Receipt No.
,t _ Date By
-
Building ' • Pate
This is to certi •q
,at th ' uest in the above application and accompanying docu r ents is accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed . • Ci , •tanner constitu ?cs a temporary Certificate of Zoning c plian • and allows construction to commence. Before occupancy, 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 Prior Lake, MN 55372