HomeMy WebLinkAboutBuilding Permit 15. 0574 -
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o� rR�op CITY OF PRIOR LAKE BUILDING PERMIT,
C--"�+ r TEMPORARY CERTIFICATEDate Recd
OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT �� t� l
���'NESo�P
I. While File PERMIT NO.
3 Pink City /6-7.® t.e
Please ,e or .tint and si L at bottom) Yellow Applicant `I/1
'
ADDRESS
IN 09 ZONING(office use)
i , C rcl-c
LEGAL DESCRIPTION(office use only)
51 r
LOT BLOCK ADDITION 0. -'
," Ai PID���/� �O � ,r
OWNER
(Name) � r
(Phone) /Sa-- (-4 Li S 9(0/8
(Address)
BUILDER
(Company Name) ( y
) (Phone) �S1--0�1/0�7;�on
(Address) "1 ` 1G t I r , `. +. (Phone) �j(u
(Contact Name G
, . ___„...„ (
ssii
TYPE OF WORK 0 New Construction
['Deck ['Porch ORe-Roofing ❑Re-Sidin
['Addition ['Alteration ^�7 _ ,� C e Lower Level LOw)cirepla
❑Utility Connection 1_��y/,iU -/••�GIL
CODE: _ i
I.R.C. ❑I.B.C. 0 Misc. �J_
Type of Construction: I II III IV V ,•
A B i
��
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 PROJECT COST/VALUE S , II a QO
( excluding land)
II 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 prop ty 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 th ermit for Just cans rthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X AGI 36 9E3 r 1S'
Signature
Contractor's License No. Date
Permit Valuation
Park Support Fee # $
Permit Fee
LEM SAC # $
Plan Check Fee
MEN `1� Water Meter Size 5/8"; I"; $
State Surcharge �
PP Pressure Reducer $
Penalty J ''i
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 $ J
TOTAL DUE $
if This Application Becomes Your Building Permit When Approved 07q, ''�` �� Receipt No. kli) 15
Date + By
Buildine Official Date V' �� Slt---
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,
issued proceed as requested. This document
b
a Certificate of Occupancy must be
Planning Director
Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 Special Conditions,if any
4646 Dakota Street Prior Lake,MN 55372