HomeMy WebLinkAboutBuilding Permit 15. 0731 c.D
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C)PRiaNCITY OF PRIOR LAKE BUILDING PERMIT, / Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
sAND UTILITY CONNECTION PERMIT 4 'Z91• (5'
I. White File
2. Pink City PERMIT NO. C,� 0/73/
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
4553 Aum1Krnb`irA, Ica-, 1\)€_. _ RI
LEGAL DESCRIPTION(office use only) ' / .,
LOT-3 BLOCK ADDITIONXAjoi /�L�G 3 4- 4' /(J PID 3�9 ow-O
OWNER ` ` ! ,
(Name) - .�Q_ I'10•,\I (Phone) /5 a- 033 .30.5 I
(Address)
I BUILDER
(Company Name) IRS U )O,.` AY .S ae_ .3 (Phone)
(Contact Name)-6(`oC ) - (OS 1 loL('4(O$ p (Phone)
(Address) 19 au C( ••L W. T..p S e_vi\RC 1 VYtv 5 5 113
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe-Roofing ORe-Siding ['Lower Level Finish ireplace�x S J
❑Addition ❑Alteration ❑Utility Connection 1 ace l. (Ari� ,�t,�}S s VI 7l
CODE: ❑I.R.C. ❑I.B.C. Misc. O 'rc0
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ i 1, ?1-5
(excluding land)
Division: 1 2 3 4 5
I hereby certify th 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 authonzed agent for the
above-mention roperty and that all c t ction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official can revo this• .•it for just -•se. urthemtore•I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X i 4810.. / . (30130, 83 (25 3-(no t S
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ qi-11,,,„ Water Meter Size 5/8"; 1"; $
State Surcharge $ 5. � \"."� Pressure Reducer $
Penalty • $ Sewer/Water Connection Fee # $
PIumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $1qi
This Application Becomes Your Building Permit When Approved (c 1iL--/ Receipt No. "2/0 11
Dated 74
�� By
Building Official Date J
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