HomeMy WebLinkAboutBuilding Permit 14. 0296 I
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P R/0,-. . R LAKE BUILDING PERMIT, Date Rec'd
0,_, , ' CITY OF PRIOR
ti(/ TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
O,. _,iy-v,
AND UTILITY CONNECTION PERMIT
A'N E`' I White File
2 Pink City I PERMIT NO. i 7 2l f' ,
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS
( 9i 0 0 Ced arty ovr) C.- fc Ic. N E
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
e c/c e f AC (Phone)
OWNER
(Name) r
(Address)
000 PLAN() Polekway Larro I1iv+v 7 Tcvi 0
BUILDER (Ph ) (, ! 1 �V 0 1
C
(Company Name) P.-...., r'/14 R• . •cie I.'n 1 y
one
rr
(Contact Name) r ' c P!c k a I (Phone)
/ k
(Address) •7(I i-$ IA W 1 ( 3 w 5A v A GF m 553/3'
TYPE OF WORK 0 New Construction ['Deck ['Porch ttRe-Roofing ['Re-Siding ['Lower Level Finish 0 Fireplace
❑Addition ['Alteration ['Utility Connection
CODE: I.R.C. ❑I.B.C. 0 Misc:
Type of Construction: I II III IV V AB PROJECT COST/VALUE $ 55o v' 0 J
Occupancy Group: ABE F HI MR SUland)1 2 3 4 5 (excluding
I hereby certify that I have 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 property and t constru will co form to all existing state and local laws and will proceed in accordance with
submitted needed P I mctaware that the building
official can revoke this permit f st cause. F ermore, hereb ee that the city official or a designee may enter upon the perform ���` ,
sou
X CRG3/!/ (7J Y
Signature
Contractor's License No. ate
Permit Valuation
Park Support Fee # $
Permit Fee
$ SAC # $
Plan Check Fee
$ 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 $ 79 75'(/
I
T-
This Application Becomes Your Building Permit When Approved Paid .7�> ByeCelp t
,Ui,/rl
I 71.Date J/ /
r
Building Official Date
This is to ce with the
ity Zoning
ested. This document
when signecertify that the request in the above the City Planner onstitutes a to application
orary Certificate of Zoning compliance and allopanying documents is in ws construction to commence.Ordinance
occupancy,a Certificateuof 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 S.E.,Prior Lake,Minnesota 55372