HomeMy WebLinkAboutMechanical Permit 14. 1159 O O 6 C) O OCOO 1 2 76 Kn
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O4 PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
``4:(014i
i AND UTILITY CONNECTION PERMIT '
1-!(0- (L-1 ,,
44,..soit. I White File PERMIT NO.
2. pink City 7
/7371
3 Yellow Applicant
(Please type or print and sign at ttom)
ADDRESS /40 ,— ZONING(office use)
t X I7 --S -I L 0,ea€ ets0
LEGAL DESCRIPTION(office use only) / y-(,>t/�-7
LOT BLOCK ADDITION PID c3 4'U'. c `
c
OWNER
(Name)
OWNER,
(Name) v '. >. �`�,ti- (Phone) CA, ( ---?3o—Q 11
(Address) J � =ice' H 2-- S L-/-e Of ye (`c Prteiv- L mo . .".3 7 Z
BUILDER4-
(Company Name) %,` 1(``` a,----,— .—e S L- 1/ ( (Phone) ^/7 ( -3/ -0 ^� (4 S
(Contact Name) NA• ',f Z� im
S v \ (Phone) a( -41 L E- l- S./
(Address) 0' 5 0 CU R s FS-/ Zr o /rz ,4 &-ce...../' i" ' ''S16,
TYPE OF WORK ❑New Construction ❑Deck ❑Porch Roofing ORe-Siding ['Lower Level Finish El Fireplace
DAddition ❑Alteration ['Utility Connection
CODE: ❑LB.C. ❑Misc.
Ty Construction: I II III IV V A B / � . ��
PROJECT COST/VALUE $ /
ccupancy Group: A B E F H I M R S U (excluding land) f
Division: 1 2 3 4 5
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 that all c ruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this p mit for jus s Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X jC , oeC es? cj (L/ 7 / (0 /V
Si re Contractor's License No. Date
Permit Valuation `/— Park Support Fee # $
Permit Fee $ 14-(- 1 J SAC # $
Plan Check Fee $ 60) 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 $ ! 7c
This Application Becomes Your Building Permit When,Approved Paid 7't 7C Receipt No. lc ! ..3
Date /6,/f( ,.. ( (f
�//BY J�/��ciy
Building Official Date y r/t..�t-.�'�� t 0 Y !, I C l
(4. i/s—'r, i'_/IIO, i'—H/o/, al
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may pr teed as requested. T 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 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 Prior Lake,MN 55372