HomeMy WebLinkAboutBuilding Permit 14. 0758 C
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'� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 7 3 v ,f
j*N B S°��
IL2: Hie
y I
type or print and sign at bottom)
3.Yellow Applicant NO.ot /¢ 75-0 I
ADDRESS
ZONING(office use)
15"g®o -sf, Gfrcw 2.4
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) /7:e(/ /1,1104 4,A, (Phone) 657 - 283 -05725
(Address) /.c'pa .Z 5/fAi l `G44.1 /2
0/
BUILDER
(Company Name) yelpiiirtor d owsci 10"4 .. (Phone) 451-yQ/-4 41 d
(Contact Name) elsee, (Ire.S
(Address) 5,tilt j cols'#� (Phone)IPS"-�d�/�''2440r91,e, JU.k! R4"inse y AAA 5.43 0 3
TYPE OF WORK °New Construction °Deck °Porch ) Re-Roofing °Re-Siding °Lower Level Finish 0 Fireplace
°Addition °Alteration °utility Connection
CODE: DI.R.c. DLB.C. 0 Misc
c of Construction: I II III IV V A B
'," Group: A B E F H I M R SU PROJECT COST/VALUE $ -t9C'��
1 2 3 4 5 (e:muting land)
I above-mentioned certify at I have. 'information ons which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent far the
official can revoke . ,t.,,'r for' l�, existingconform to all state and local laws and will proceed in accordance with submitted plans. I am aware that the building
l F/, hereby agree that the city official ar a designee may enter upon the property to perform needed inspections.
X Be 633 bf( ?-zs-rt 9
Signature Contractor's License No. Date
Permit Valuation Park Support Fee ## $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8";1"; $
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 I Paid 7 q, -1,s----
• No. 17'j 1 ()
Date J r( (
Building Official Date
This is to artify that the request in the above application and accompanying documents is in accordance with the
ilCity Planner c on itutes a temporary Certificate of may Proceed as requested. This document
signed by the Zoning compliance and allows conmuction�mmence. 13efiue occupancy,a Certificate�Oornpancy mtrat be
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372