HomeMy WebLinkAboutBuilding Permit 13. 1174 J
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of PR.t CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
-. pi AND UTILITY CONNECTION PERMIT U j L Z _ II U
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4I I. White File PERMIT NO
.......) 2 Pink City Ci
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3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
'.71. iq 'r ricec-u67 Kio,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUILDER ,.�` 1 r
(Company Narite Q1 ��. Pit, riarcil cvNit (Phone) 65 lO � ,1
4
(Contact Name) k" (Phone) 6D1.2 ''' e `414�s �l
(Address) 7. �� 1. he / Am r 5 b
TYPE OF WORK 0 New Constru ion ❑Deck ❑Porch [Me- Roofing DRe- Siding ❑Lower Level Finish ❑ Fireplac
❑Addition Alteration ❑Utility Connection - �j, Cr l /
Misc. / e' j. ( Z e Lfil IV N ' CODE: ❑I.R.C. ❑I.B.C. � � �� � r � � '
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ c. t
Occupancy Group: A B E F H I M R S U (excluding land)
Divis : 1 2 3 4 5
1 hereb f certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above - J enttoned property a : t' . t 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
officia / an revoke this per , t fo j e'ause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. •
x . �.' �1 1 Ct 0'70 / 6 -22 -.l )
Signa a Contractor's License No. Date
Permit Val ■ ation Park Support Fee # $
Permit Fee $ 2 S ' 4 fti SAC # $
Plan Check Fee $ / 42 Z se" 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 $ 1- / 73
1 / N. 7� � (� /
This �p ti . gif , mes Your Building Permit When Ap Paid 4 7,1 � - e ceipt No.
/ f, ...........(4, Date / ZL , 1) Y -
I z IS
Building OTT; ,. 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 Prior Lake, MN 55372