HomeMy WebLinkAboutBuilding Permit #11-0811 F PR IO
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�, ,;�\ �, 9 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � /
"�' '�` AND UTILITY CONNECTION PERMIT 9, 7./�
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�"'''"` F ��` PERMIT NO. ,j� S! I
2. Pink Ciry
3. Yellow Applicant f
ease or and s' at bottom
ADDRESS ZONING (ot�ice use)
S 5 Ga� ode��.�� C�'r�.�P
LEGAL DESCRIPTTON (oflFce use only)
LOT BLOCK ADDITTON pID
(Na�me) R � f1 r' ��� L e (Phone) g 5 � `� 8 lv 19 g�o
(Address) SS(c� vZ Q✓ l'l Cl/" i �►O/'�-a�-P �
BUII.DER
(CompanyName) se�ec# �j�e/`S/'2eK� ��US�IPvc.�/O� (Phone) ��'�`I'�l �O
(Contact Name) �� �ec�e f (Phone) Cfl S Z 5`? Z y' a 7 9
(Address) 1 Z� C-erkrc a i�t ►^✓C '� � �� T s J Zd .
TYPE OF WORK ❑ New Construction �Deck �Porch Bite-Roofing ❑Re-Siding OLower Level Finish ❑ Fireplace
�Addition ❑Alteration �Utiliry Connection
CODE: ❑I.RC. �I.B.C. � �
Type of Construction: I II III N V A B 5 , 7 OQ
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S •
Division: 1 2 3 4 5 (excluding la�t)
I hereby certify that I have fiunished infoimaflon on this appliation which is to the best of my knowkdge uue and cornd. I also certify that I am the owaer or authoriud agent for the
above-mentioned property and that all construction will confocm oo a11 adsting state and local taws and will proceed in accordantt with submitted plans. I am awaze that the building
official can revoke this pemrit for just cause. F�rthumore, I hereby agee that the dty offiaal or a designee may enber upon the property to perForm aeeded inspecaons.
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� Signature Contractor's License No. Date
Permit Valuation Pazk Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalt3' $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer 8c Water Permit Fee $ O�� $
Gas Fireplace Permit Fee $ TOTAL DUE $ r/�
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This Applicacion Becomes Yo�a Building Permi[ WheaApproved Paid Re i t No.
Date
Buildin Official Da�
This is to certify that the request in the above application and accompanying documents is in accordaace with the City Zoning Ordinana and may proceed as requested This document
when signed by the City Planner consatutes a temporary Cectificace of Zoning compliana and allows construc�on to commence. Before occupaacy, a CettiScau of Oavpanry must be ,
issued.
Planning Director Date Special Conditions, if any
24 hour ootice for all inspections (952) 447-9850, tax (952) 447-4245
4646 Dakots Street S.E., Prior Lake, MionesoW 55372