HomeMy WebLinkAboutBuilding Permit 08.0073 ,, ii ----
PRIJ CITY OF PRIOR LAKE BUILDING PERMIT, 109 Date Rec'd
,, a TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 2
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• N NES / White File PERMIT NO .
2. Pink City DS- 0 073
7
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 5� Z- Z Cr�o y Go ac T.41 I_ S.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID Lb - Z I , 0
OWNER ,
(Name) ON,J 5A-A-A CPA A -t: r „ s. ic[ (Phone) Co ) Z-- Z g Z — Z y 0 Z.
1
(Address) /0 7 fJ j I a vLOro 14.... d- r At, o ae. l._A 1'-c
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re Roofing ❑Re Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: R.C. ❑I.B.C. El Misc.
Type of o nstruction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E H I MR S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that 1 have furnished information on this application which is to the best of my knowledge true and correct. 1 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 for Just cause. s.
..Fuurthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
04./&
Signature Contractor's License No. Date
I
Permit Valuation Park Support Fee # $
a
Permit Fee $ ) SAC # $
Plan Check Fee , $ /
�1 Water Meter . • 1 "; $2 S o
State Surcharge
■ I 0 , Pressure Reducer $
Penalty .A Mt A Sewer /Water Connection Fee # $
Plumbing Permit Fee _ Water Tower Fee # $
Mechanical Permit Fee Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 3 2S, b a
This Application Becomes Your Building Permit When Approved Paid 5Z5 6 o Receipt No. 55 SS
g " PI∎4 eJ /2-F /o? Date 0 7p, r /. & By
Building Official Date
his is to certify that the request in the above application accompanying documents is in with Zoning Ordinance and may proceed as requested. This d ocument
when signed byf the City Planner constitutes a temporary Cert i and ficate acco of Zoning doc compliance and allows construction the to City commence. Before occupancy, a Certificate of Occupancy must be
i ssued.
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
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