HomeMy WebLinkAboutBuilding Permit 15-0037 . . . . 1
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xPRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ...._
AND UTILITY CONNECTION PERMIT l '/%� S
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4 SP' I. White File
�NES� 2. pink city PERMIT NO./5", .0 7
3 Yellow Applicant ( . �. /
(Please type or print and signat bottom)
ADDRESS 7. i e "0( ?c,;:% Hili ii,,c6,4/ j4
,e_ AAS 531-a ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ,_
(Name) C/ �'�-�G ✓� (Phone) - tZ_a____
(Address) clAivc IONS C A120
(Co DER Name) J-Y'`.7 421)1 j s vAr i . )1yiEN l ci (Phone) -7(3-3 i r-/O C't
(Contact Name) • 1 r • Y (Phone) -Q4: /02.—
(Address)
0.(Address) /OM '7f' s 1,14.2. 6
TYPE OF WORK ❑New Construction ❑Deck ❑Porch Ake-Roofing ❑Re-Siding ['Lower Level Finish 1:1 Fireplace
['Addition DAlteration ['Utility Connectio
DI.R.C. DI.B.C. ❑Misc.
Type of Construction: I II III IV V A B / Sof, C.41Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ /�1 ,
(excluding land)
Division: 1 2 3 4 5
I hereby certify th t I have furnished information on is 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-mentione.I property and that all. nstruction ,I ill conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revo 7 this permit for just ca . Further�ore,I hereby agree that the city official or a designee may
enter upon the property to perform needed spectu ns.
X .ice / �OA a cZe11 417 1 / d
f / Sig :ture Contractor's License No. Date
Permit Valuation Park Support Fee # $
.t.,
Permit Fee $ /� SAC # $
Plan Check Fee $ / / Water Meter Size 5/8"; 1"; $
State Surcharge $ r`J9 Pressure Reducer $
Penalty $ 'J [ r� 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 $ -2 `"
This Application Becomes Your Building Permit When Approved Paid 1 eV Receipt No. 4
Date " By -1-
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. Tf is document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupz.ncy 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