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HomeMy WebLinkAboutBuilding Permit 15. 1180 a 2 © 0 0 ■ 222 0 8 K§ 0 a 0 © 0 . a 0 $ 3 mgt c8 § / t ] m EB2B P CI) 0� ■ \ ■ ■ 7 § § s § zq r 41 \ k r o • m o 73 \ � ■ 0 0 Z A ,, 000000 k x g 0 0 mr �tmr $ ? xQ §mx R ; E ■ ■ � § m O n ■ 0 zzi0 - ■ z q r / 0 r 2 0 0 § 0 k o m k 0 o 0 22 0000 ❑ 0 / § 0 8 r < ® emm2§ Dr - z j A ›rnniEK 53 -n7, -4r g z I r o of PR/04, CITY OF PRIOR LAKE BUILDING PERMIT, CY' TEMPORARYAND CERTIFICATEUTILITYCONNECTION OF ZONING COMPLIANCE Date Recd 4.1avpiE sot* I. White File 2. Pink City I PERMIT NO. _ J/g/� (Please type or print and sign at bottom) 3 Yellow Applicant ADDRESS 1 r J i `D VAN S I k NA 'Q,-v.2 I ZONING(office use) `i\ r'iS-01 LEGAL DESCRIPTION(office use only) - LOT BLOCK ADDITION PID25- OWNER (Name) (Phone) (Address) BUILDER 1 (Company Name) r� �1 7 0-VA,C_ SV`lirgvQ.Y'-�C�,6 (Phone \c \, (Contact Name) lJ r',1,.o„� v ) `� 1 V��e ��C� (Address) (Phone) A ( --L,1-� c\,/e. 'f t.l-,Irv\G- W.;, '11i1`l TYPE OF WORK 0 New Construction ['Deck 1 DAddition DUtility Connection ❑Re-Siding ❑Lower Level Finish ['Alteration ❑Fireplace CODE: DI.R.C. DI.B.C. 0 Misc. Type of Construction: I II III IV V A B / : Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ �$W Division: I 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 prope 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 revoke this mit for just eau urthermore,I hereby agree that the city official or a de nee may enter upon the property to perform needed inspect ins. Signature Contractor's License No. ' Date Permit Valuation Park Support Fee # $ Permit Fee $ 7X 75- SAC # $ Plan Check Fee $ Water Meter Size 5/8"; I"; $ 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 Application Becomes Your Building Permit When Approved Paid I 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 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