HomeMy WebLinkAboutBuilding Permit 15. 0716 J1..
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Or
of PR/o4. CITY OF PRIOR LAKE BUILDING PERMIT,
a . TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
AND UTILITY CONNECTION PERMIT 6 z -
-05: IS
44NESO1P
. whitePink FileCity OI PERMIT N .
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Please i or .rint and sir? at bottom) 3 Yellow Applicant L/�/�\Jl (/r�/
ADDRESS
21,3 3 G \ L- N ZONIN (of a use)
LEGAL DESCRIPTION(office use only) /
LOT Iv BLOCK 3 ADDITION ke/450472 � % /410,64). `�VJ PID Z= Vt",d7/
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OWNER
•
(Name) •3• .,/,- ... L. 4-M yit 1�5trt 1 14A V''1 C kSc�
(Phone) 2- (2-4*-- V3 LIa
(Address) 23 3 ,,,r-r. P N W "lPerf �—'L-
� I.&4 5)c3 12
BUILDER 1� � - �+ ,
(Company Name) C{A,TL1 I 'evL be-S _ (Phone) 7 -3/S 7
(Contact Name) 3�-�S 3 D �S
C� _ ^ (Phone) Z1 g': 4 2.$- L e
(Address) 0J 70 Co Ie.L..S-( SLt,.c 2(O �(zr `tmje. iv IU 5r36,01
TYPE OF WORK 0 New Construction ODeck
❑Porch ,Re-Roofing ORe-Siding OLower Level Finish
['Addition ['Alteration ['Utility Connection ❑Fireplace
CODEI.R.C. ❑I.B.C. 0 Misc.
Type o Construction: I II III IV V AB
Occupancy Group: ABE F HI M R S U PROJECT COST/VALUE $ ZZ�jp�
Division: 1 2 3 4 5 (excluding land)
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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 the building
official can re oke this ermit for t c use. Furthe ore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
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Contractor's License No. Date
Permit Valuation
Park Support Fee # $
Permit Fee $
7 SAC # $
Plan Check Fee $
COater Meter Size 5/8"; 1"; $
State Surcharge $ J J
Pressure Reducer $
Penalty $
Sewer/Water Connection Fee # $
Plumbing Permit Fee $
.. C7----"5" Water Tower Fee # $
Mechanical Permit Fee $ r
Builder's Deposit $
Sewer&Water Permit Fee $
Other $
Gas Fireplace Permit Fee $
TOTAL DUE $
This Application Becomes Your Building Permit When Approved
Paid (c— Gj^ Receipt No.
Date 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
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,
issued proceed as requested. This document
b
p. y,a Certificate of Occupancy must be
Planning Director
Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372