HomeMy WebLinkAboutBuilding Permit #12-679 oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE -�
� X AND UTILITY CONNECTION PERMIT ��' �'�' ��
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a �NNES��� 2 r �;, PERMIT NO. �.�
3 Yellow Applicam
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ADDRESS ZOI�TING ��Fl�,�� �se�
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
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O aWNER ��.`���. � ��C��''�-� � �� `�� � (PhoneN� � �JC,_ ����-1,(��
(Address) r%L�-- �5 � �j ���
I BUII.,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
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TYPE OF WORK ❑ New Construct�on eck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Fimsh ❑ Fireplace
❑Add�uon ❑Alter o ❑Util�ty Connecnon
CODE: �I.$.C. ❑I.B.C. ❑ M�sc.
Type of Construction: I II III IV V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (excluding land) I
Division: 1 2 3 4 5
I he y c �ty that f have isHed mfrnrm s appLcahon which is to the best of my knowlcdge true and coirect I alsu ccrufy [hat 1 am the uwne� i» authonzcA agcnt for the
ab ve- noned properry a�n�d t� t all cu shucnon wil onform to all exisang state and local laws and w�ll proceed m accordantt wuh tiubm�tted plans I am aware that the buildmg
I utT �an eirr�4for �st caus Furthermor , I hereby agree that the c�ty offinal or a designee may enter upon the p�operty to peiform necdc mtipecuuns
X ye' � / � �� � ��
Sign re Contractor's License No ate
Permit Valuation �� �; �'� �,i � Park Support Fee # $
Permit Fee $ ' � V� °_ �v SAC # $
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Plan Check Fee $ ' � j Water Meter Size 5/8", 1", $
State Surcharge $ •? � � Pressure Reducer �
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Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas F�replace Permrt Fee $ TOTAL DUE %� �, � � Z - , $ / � ^ � '�
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This A p ti ecomes Your Building Pernut Whe Appr ed Paid e1 t No.
Date
�. ,
Bi dme (�ftia: Date �
This is to cernfy at t�•qucst m e appLcauon and accompanymg doc ents �s i acco�dance w�th the Gry Zunmg Ordmance and may p�ocreA ati requc�ted Th�s document
when signed by Ci lanne� consututes a remputary Cetttficate of Zontng mphanc • nd alluws consnucuon ro commence Befuie uccupancy, a Ccinticate uf Occupancy must bc
issucd
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P 'ng Director Date Special Conditions, if any
24 hour noticc for all inspections (952) d47-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
TYPE OF WORK
USE OF BUILDING
PERMIT NO. ATE ISSUED •
BUILDER PHONE
NOTE: THIS 1 NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
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PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FINAL 3u /
FOR ALL INSPECTIONS (952) 447-9850
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