HomeMy WebLinkAboutBuilding Permit 11. 0349 V
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tDe PR IpCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
en AND UTILITY CONNECTION PERMIT
en + 'tt' I white File
xxeso
2 Pink City PERMIT NO. If,. ` 49
3 Yellow Applicant
(Please type or print and sign at bottom)
4 ADDRESS ZONING (office use)
t.5 ' 22 6` !I'd()IY.
LEGAL DESCRIPTION (office use only)
J LOT BLOCK ADDITION PID
______
�.L OWNER
l' (Name) /9 /Y- /I` r • i i4 0 'pa ,, • . Phone) 447 -4S:1,257)
(Address) /VS
4 (C Name) r ,.. !� , r.: i� /t..fe*: —. l' 4 ,4;2ri (Phone) ;/.f.Z 7''2 - 7gf -'c�
(Contact Name) Ci7a / ,1--‹ (Phone) k..7 3 ggc$ 4
(Address) '9 t. Imo- j ii ran pi_ (Y) 1
i
TYPE OF WORK "'New Construction ❑Deck ❑Porch Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration DUtility Conne io
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II HID' V AB PROJECT COST/ VALUE $ __ _
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that [ ve 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 c 'ty 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 rev •c2this permit for dust cause th ore I hereby agree that the city official ur a designee may enter upon the property to perform needed m� c ms
Signa Ire Contractor's License No ate
Permit Valuation 2-S j. — Park Support Fee # $
Permit Fee $ 1 ,4, TS SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; I "; $
State Surcharge $ c— ,.- 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 $ I TOTAL DUE S / ....q .. - 7
Thi pp ation Becomes�'our Building Permit When • • pproved Paid 7 Receipt No. (O Z�
.4
Date 1 1 By
s 0 fir - • 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 Cenificate of Zoning compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must he
issued
Planning Director Date Special Conditions, if any
24 hour notice for alt inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372