HomeMy WebLinkAboutNo Survey for 11. 1320 tCITY OFPRIORLAKE BUILDINGPERMITDate Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT �L /Z.
4.0iNt3 SOC I. White File `
2. Pink City PERMIT NO. // /3 Z6
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
37761 67-e? 7)/"1-%e 15~ //a/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ,ii
(Name) 1 r it.Y"y el- fii,z,r-A j 6e,,,--S (Phone)
(Address)
BUILDER i,,
(Company Name) �` e.5 ..f' / K7 '/' S (Phone) b5/-4166 "6/e7
(Contact Name) Sc O/7 /44-A.,---1---) / (phont/ aS/ S'2-? ''v5,
(Address) tt�(�3 3 �/ ��..er-7 4//6 /07,-e /l/` 7 //T j/i''.4) t s ar
TYPE OF WORK ❑New Construction ,Deck ❑Porch ORe-Roofing ORe-Siding ['Lower Level Finish ❑Fireplace
['Addition DAlteration ['Utility Connection /�
CODE: .R.C. DI.B.C. ❑Misc. ����� / t_1
Type of o struction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
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 con uction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official ca this per..t4,-lust t Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed ins rtio s.
07
X .41,` ,o(,0 -3 L/4202_ / //
'Signature Contractor's License No. Date
Permit Valuation 3 0 00,
0` n 0 Park Support Fee # $
Permit Fee $ g El 2.5 SAC # $
Plan Check Fee $ :517 3 Water Meter Size 5/8"; 1"; $
State Surcharge $ / V i 1 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 404 rL.t.3,i ( $ /4�, f
This • 1to Becomes Your Building Permit en A oved Paid /4 7, I ceipt No. 4Q4711
IZ Date /Z. /3 it B
Build-Ulu Official Date
This is to cc that t request in the above application and accompanying docu ents i in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signe. • 'e CiPlanner constitutes a temporary Certificate of Zoning co plian c and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
A. I��.._' (7 Z
_ r �
= ' IIate Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372