HomeMy WebLinkAboutBuilding Permit 14. 0940 2 N
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04 >'R I�� CITY OF PRIOR LAKE BUILDING PERMIT,
/17
Date,',
tiAN TEMPORARY CERTIFICATE OF ZONING COMPLIANCE %'
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4., 5AND UTILITY CONNECTION PERMIT /
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2. Pink CitI PERMIT NO. RI q46
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
I 0143 Cate-�rI019A- b (cit 1
LEGAL4,
DESCRIPTION(office use only) _
LOT BLOCK ADDITION Pr /L A 'C ' Zlb./i PID PID DOq ..- 2 r
OWNER � pp r 1-raJA � ( Z -MO' ��J/CJC_
(Name) Jes R (Phone) 1 `.----
(Address) 1 0143 1.cci'k lo 0 d Cirr'( or bap 10,f N ;c3 7 Z
(Company Name) + d L 'i Wi vid (� (- ''u yy?I' WV. �5(Phone) ( 12"3;3 572.D
\QL (Phone) 101 Z 39 3 S 7 4b
(Contact Name) � , vAnste a �� �� t �� ��.� ��� h(Address) 2- 1ut A� + ' V`UriI � P'S
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace t
❑Addition )Iteration ❑Utility Connection
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CODE: DI.R.C. �LB.C. ❑Misc: 1 "� Ce y
Type of Construction: I II III IV V A B 2-f ! DU
Occupancy Group: ABE F H I MR SU PROJECT COST/VALUE $
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 for 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 thh:building
official can rev.ke this permit for j..t cause. Fu more,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x /1_, / / _40 --- 3C.-(V 3 ( 9 3 7-- A /') O
inte Contractor's License No.
Permit ValuationPark Support Fee # $
Permit Fee $ SAC # $ ,
Plan Check Fee
$ 4ill
Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
.4:7
Penalty $ 9 Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder'sDeposit $
Sewer&Water Permit Fee $ Other $P `7 �—
Gas Fireplace Permit Fee $ TO DUE $ 7 l
tteThis Application Becomes Your Building Permit When Approved "7(. / Receipt No. i "":9 /f3:1
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By
Building Official Date SrJ
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. Thin 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 S.E.,Prior Lake,Minnesota 55372