HomeMy WebLinkAboutBuilding Permit 12. 0789 .
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C ./ PRI0
� CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Recd
50�
t. white File
2. Pink City PERMIT NO. i _ o 7 sy 3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS D / ZONING (office use)
I 'M 9a — /5 "/- Alai Prior La/& //iiV 53 3 72.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID Z. Z 3(0.010.0
OWNER /f /n �,J / /
(Name) / I elf +' Abry &ar�2OrGj (Phone) 6/Z -159 - «qqc ce / / /
(Address) 'yo go - /✓ -7 - 5 /l/ i}, 8P/k" 6(Ce /MI 55377
BUIEBER CON1KAcrot2 : -f (4 (Company Name) S an d au- sire ark.. (Phone) g52 - 4 -9/00
(Contact Name) Ke yin 59riciev.. (Phone) 6/a - 363 - D/el
(Address) 97z.5" L yn d a I& Avg S, gloomi in/'l 5.5 4e2o
TYPE OF WORK El New Construction ❑Deck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish El Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. [NIMisc: WM CfOA) re pl , k_e - e - v + 2. wind ow,
Type of Construction: I II III IV V A B i In ba samor'1r
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ .2.
Division: 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 tate • ocal laws and will proceed in accordance with submitted plans. I am aware that the building
official revo this per it for just cause. Furthermore, I hereby afire at a ��ial or a designee may enter upon the property to perform needed inspections.
X an 4 r (/ ,// 9C c� ?25/ 7 - /3 .1 2 -
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 $
This Application Becomes Your Building Permit When Approved Paid ', 73- Receipt N O 4 � ' . 5/ 5
Date 7me1.2-- By /. r ../
Building Official Date
This is to certify that 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 the City Planner constitutes a temporary Certificate of Zoning compliance 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 S.E., Prior Lake, Minnesota 55372