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HomeMy WebLinkAboutBuilding Permit #13-613 o � PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd � ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� l�� � j � .. � AND UTILITY CONNECTION PERMIT U � 4�N�veso'�� i. wn��e File ( PERMIT NO �3 z r�� c�� I ,� / _ / '� 3 Vellow Applicam . (G7L_ Please or 'm and si at bottom ADDRESS �� � � �� � � � ��� ZONING (o�t'ice use> lJC.�! �/f s � LEGAL DESCRIPTION (oflFice use only) � LOT � BLOCK � ADDITION � L�d ��Zd�E�S PID o?5� 7Ja • Q?� � OWNER �� �O � I� C V'(�c�. t,J �P�o � � � "� � (Name) (Phone) � " / (Address) � ` / � ` �'�� � � � � BUII,DER D� ; �S � C �o c�� J bto" / 7°?� (Company Name) (Phone) (Contact Name) � � �' °� (Phone) � r (Address) � � � � � �l c� i�..� L � �' � �� O�-/'1 /� /✓ TYPE OF WORK ❑ New Construction �eck ❑Porch ❑Re•Roofing ❑Re•Siding ❑Lower Level Finish ❑ Fireplace ❑Addition �Alteraaon ❑Utility Connection CODE: I.R.C. �I.B.C. � Misc. Type o Construction: I II III IV V A B pROJECT COST/VALUE S ��� �� o Occupancy Group: A B E F H I M R S U (excluding land) Division: 1 2 3 4 5 t hcreby certiCy that i havr Cumished information on this appiication which is tv the best of my knuwiedge true and cvrrec[. I also certify that I am the uwncr or authorizcd agen[ for the above-menho ed pr rty and that all con., ietion wii! wnform to atl existing state and local taws and wiil proceed in accordance with submitted plans. [ am aware that the building ufficial c e is per i just Furthermore, I hereby agree that the city official or a designee may enrer upon the property to perform needed �nsp��etions. X �� 3 6 D-S`�/ � l~ � Signature Contractor's License No. Date Permit Valuatioq� �� r Park Support Fee # $ Permit Fee $ � Y � SAC # $ Plan Check Fee $ Water Meter Size 5/8"; 1"; $ State Surcharge $ � `, _ Pressure Reducer $ Penalty $ SewerlWater Connection Fee # $ Plumbing Fermit Fee $ Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Perrnit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DUE $ � . This a n �es Your Bwilding Pemtit rn proved . ReCei t No. Date B c � ( Buiidi _ •ia Dat This �s to ertify t at the requcst in the above appiication and accompanyfng docu ents is accordance with the Ciry T.�ming Ordinance and may procreQ as mqucsted. Th�s dixument when si � b e Ciry Pianner constuutes a temporary Certificate of Zoning co plianc nd aliuws constn�ctian tu commence. 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