HomeMy WebLinkAboutBuilding Permit 13. 0564 J
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o f pR1 ° "P CITY OF PRIOR LAKE BUILDING PERMIT, Date a 'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE i �I J3
AND UTILITY CONNECTION PERMIT ,` /
4f 'NNE SO
I . white File PERMIT NO ///��� )))
2. Pink City
pp ] L,� /�1�.6 �
3. Yellow Applicant ! J (f'J
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I 1 4 & / G 16, te 5 .4,,,e. S ---,
/ SD
LEGAL DESCRIPTION (office use only)
LOT BLOCK .. ADDITION /t .b & l z N`D /A& a PID 45'l3 0/6 'Q
OWNER Ah ) _ 3/
(Name) T `�"" 1 (Phone) f / 2 °.• 4 Y 2 .
(Address) 1 We i Lt 1 eh Ave e J . ,.. ? d) LILL.e r AA 5
(Nam e M 'l6Yt .S (Phone) 6 5/ — 553— Q) 3?
(Contact Name) e, t).-'-f- t�.` (I 1 14.-A_ (Phone) ...._,-a —..- -e-
(Address) w (,,n\ ri tat a Le Lk � 10. a
t- `f � j i CGtnia. , AA, NI 53 +3 -1
TYPE OF WORK ❑ New Construction ❑Deck ['Porch DRe-Roofing ❑Re- Siding
❑Lower Level Finish ❑ Fireplace ❑Addition ['Alteration ❑Utility Connection
Val ` 0 5 -:
MISC. ...? t pkLt t;ek�'v� - � PROJECT COST /VALUE (excluding land) $ 7.," .
r t / , C i.
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 revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon rty to perfo n inspections. / Z
X = -ce /4 ' %' 5 c ct ( 4 - r1 C (r: 6 -ells f f ��
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 $ City SAC and WAC # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ /9 , /2__C
- This Application Bec.t* es Your Building Peuuit When Approved C it1$ 1 1 .- �� Receipt No. tog 1 S S
ate By
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This is m akth�t!{r`yb ie t to hying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when � ij st emporazy CeitifIcat of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
lends*" t . iri rUU4 flSa t on earn sto ry.
and in halls to sleeping rooms
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 - 9850, fax (952) 447 - 4245
16200 Eagle Creek Avenue Prior Lake, MN 55372