HomeMy WebLinkAboutBuilding Permit 15. 0867 J
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of pR�o�P CITY OF PRDate Rec'd
: ; TEMPORARY CERTIFICATEIORLAKE OF ZONINGBUILDINGPERMIT
COMPLIANCE
AND UTILITY CONNECTION PERMIT
4.4,NESOl� I. White City PERMIT NO6--E&7
2. Pink Cit /`/
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use) •
Z9/7 CJT w) ad
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) 'Dax 4\ I itSCk »e r( cPhone) 5 2 232- 9603
(Address) e91? ee,poier. Ed --5-4-1 t j'"/1 ems. C sc / >2>274,--r� 5 372
BUILDER1
(Company Name) ��iv Me' i E. �ik$`l� -L(Phone) 74 3 - z��'rl6�t�
(Contact Name) GJ' 97 ,4 (Phone) 74 3 - C'2(f—/6 5lo
(Address) 22 cf'5T eie Sl Tt -/C t /C / ,7yl 7.44.4] ' .SS c•./ '7
TYPE OF WORK ❑New Construction ❑Deck ❑Porch NRe-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑LB.C, ❑Misc. C4 -e o", a0_,,,
Type of Construction: I II III IV V A B ca •
Occupancy Group: A B E F H I M R S U 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 the building
official can re ermit for just cause. w more,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X , , 1'C'6B 2/ S- '7-?9-/�
i_ azure Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 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 $
This Applic. 'o' :•comes our Buil ' g Permit When Approved Paid /5`, 7 Receipt No. 7�
/t/..
/ i 7-29-7 Date "� � By 'y)
t'`in_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. This 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
4646 Dakota Street Prior Lake,MN 55372