HomeMy WebLinkAboutBuilding Permit 15. 0463 _ 0 1U)
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erafCITY OF PRIOR LAKE BUILDINGPERMIT, �7\./ Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
I AND UTILITY CONNECTION PERMIT ,S /l, /S
67
♦in'iYEsotr I. White File
2.Yellow city PERMIT NO. y
6.4
3(Please type or print and sign at bottom) Applicant a
ADDRESS ZONING(office use)
5CoR1- Cc-cd`lNct,.1 'RI "Trat1 52. • Pub
LEGAL DESCRIPTION(office use only)
LOT2—BLOCK ADDITION e D/tiA1-, o '� /;ri, *1 %W I PID G7 5--gf/— ®6 57-0
OWNER T 1 1 `a��� (� , L( � / -l Jam/
(Name) ZL)CU)1 d -k I�D (Phone) l5 6 `'i`l `l9 7v T-
(Address)
1 BUILDER
(Company Name)? e r 'u..'Xa.\ Ahc.{-e(�_r.. (Phone)
(Contact Name) '�t`6C..1N -- loS ( - 64-40 (Phone)
(Address) i9 a b C V. . ',C, W. e ci s C L, C 1 ItyvV S S 11'3
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ❑Re-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection ace �0LAS r JLU w s 4 I z/�-1h.
� d�r
CODE: DI.R.C. ❑I.B.C. ❑ Ic.
CA 4s.v ci iS GP a r ;
Type of Construction: I II III IV V A B ^2 J
PROJECT COST/VALUE $ as d0
Occupancy Group: A B E F H I M R S U ) J
Division: 1 2 3 4 5 (excluding land)
I hereby certi 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 authonzcd agent for the
above-men . ed property and 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 f oke this permit • cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed mcpections.
X / cC� (30130, 8 3 )5—
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ . SAC # $
Plan Check Fee $ 14, i7Water Meter Size 5/8"; 1'; ' $
State Surcharge $ ) , Pressure Reducer $
Penalty • $
Sewer/Water Connection Fee # $
PIumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ ' /4
( Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ s
This Application Becomes Your Building Permit When Approvedi l ` �� Receipt Na 1153
Date �. ' (. 'S By
SA
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 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