HomeMy WebLinkAboutBuilding Permit 13. 0651 J i..
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o� 1'R CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
ti TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
to AND UTILITY CONNECTION PERMIT
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I. White File
2. Pink City .. 1 PERMIT NO. /3 04i1 1
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS • ZONING (office use)
5041 6kZen Oaks Trail 56
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name)
OWNER 5h von i 13 • / 1 !'tan (Phone) q. _447' g25l ?'
(Address) / 5 G -Y.e.c ak � � � s ai � S 0 1 .e MAI -- 3
Com Name Sa r- , fr fro S turn /c e ('0 (Phone) %Jfa ' - `tad
(Company Y ) C '7? � 1 & 57
(Contact Name) C a -`o (U n Dl P 1 s/ 11Oft (Phone q 0
(Address) 10751 rxcelcior ) Wie . /6 S , M✓ 575 -34 3
TYPE OF WORK ❑ New Construction ❑Deck :Porch DRe-Roofing DRe-Siding ❑Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. [XMisc:
RePta 4" 0t lao ws . 00 Sfrac!'u --f chi .
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ + �/ F 01
Divisiatn: 1 2 3 4 5 (excluding land)
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 I 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 evoke this permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 9 c q 3104' "1 ' �! 3
Signature
Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 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 $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ / " 7-r
This Application Becomes Your Building Permit When Approved Paid `ir
Recei.t .;. SEEM NMI
Date SIMMINE01 B `g
Building Official Date
This is to when signed by the a City Planner constitutes a tempo ary Certificate of Zoning compl compliance and allows construction o Ordinance and may
Before occupancy, proceed Certifica a requested. This document
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.E., Prior Lake, Minnesota 55372