HomeMy WebLinkAboutBuilding Permit 15. 0708 • 5 ❑ 0/11- C) 000000
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OF PRIp4 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F TEMPORARY CERTIFICATE OF ZONING COMPLIANCE6. 744 iCAND UTILITY CONNECTION PERMIT
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40,„EsOt• I. White File
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3 Pink Cityl PERMIT NO / D�De
Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
535w LA of LJ -V/ R �
LEGAL DESCRIPTION(office use only)
LOT BLOCK ) ADDITION4Z47O/E 6Z-en 51 4W/V PID f [ `(-MOOR
OWNER 00
(Name) sJ r -QC4 P ec.-\/ (Phone) 20) 5 + - 9e2‘,
(Address)
BUILDER
(Company Name) flec,)cS IA,rl (Phone) 9- 061°a.
(Contact Name) an9 til An_ (Phone)
(Address) SY0 3 f-04 S 1 Co 3 l
TYPE OF WORK KNew Construction . 'beck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 04 0' o
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
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 revoke this permit for just cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation /„/'j/!7 ? Park Support Fee # $
Permit Fee $ l✓� Z , o SAC # $
Plan Check Fee $ ' /3 Water Meter Size 5/8"; 1"; $
State Surcharge
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$ Pressure Reducer $
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Penalty Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ IBuilder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ „3,7&/ 6,/
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This Apt do I ecomes Your Building Permit n Appr edas I. t•3 Receipt No. / A
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Bui . „Official Date
This is to certify •it the re.lest in the above application and accompanying documents in accord ce with the City Zoning Ordinance and may proceed as requested. This document
when signed by, ity nuer_cimaautes a temporary Certificate of Zoning complia cc and alio s construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. )40
41
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•lannin.`_' -ctor Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
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