HomeMy WebLinkAboutBuilding Permit 13. 1351 ( \
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(4 RIO � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
, ' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
(Z-.). AND UTILITY CONNECTION PERMIT
*NE sod
I.white Fife PERMIT NO
2. pink Cit .p �� /
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER �J
(Name) /57 ih 7 � f�P+J r'— ' e-/1.C (Phone) —
(Address)/5—7 y.S�I oLe a/� 76�►T/4 lie 5
BUILDER ✓ / �^
(Company Name)J ih/74a-3 c, �X' d5
-7 .moi (Phone) —
(Contact Name)G.--e°7'7 - a r/5 a r7 (Phone) 7C3- 53 C —
(Address) 8CGC,83e_- e/5y 0s5e p ml? 5S3
TYPE OF WORK ❑New Construction DDeck ['Porch ❑Re-Roofing Siding ['Lower Level Finish 0 Fireplace
['Addition ❑Alteration ['Utility Connection
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CODE: ❑I.R.C. ❑I.B.C. ❑Misc:
Type of Construction: I If III IV V A B c�
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ j /j 6 53' '0
Division: 1 2 3 4 5 (excluding land)
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 far the
above-mentioned property 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 bui ding
official can re'oke this permit for'ust cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections..
• �� ge 003 77 /7';-
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Signature Contractor's License No. Dae
• 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 $ '9 7,-"
This Application Becomes Your Building Permit When Approved Paid 79. Receipt o. 7d ik
13
Date 1171///13 BY
Building Official 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 doe iment
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy trust 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
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