HomeMy WebLinkAboutBuilding Permit 15. 1005 4.
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A.(---;PRIJ' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
��NNESO�� I. White File PERMIT NO.
3 Yellow City IJ. I �t1�
3 Applicant ♦ L/
(Please type or print and sign at bottom)
ADDRESS
ZONING(office use)
1/9'6/ /4 44 f I/Ak 5$-► .1r2-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) M` A- - 4--- (4-IrtA GO( lSI)J.') ( one)
%
(Address) 70`7 /1/1C4.c its-, G,61,. 1( S1-►' 2 I-
BUILDER
(Company Name) Al I b A r Cn
,.idr-rt/t d-i i
(Phone) (,P/Z- nci — 0 5-
(Contact Name) ySa r, `,i f (Phone)
(Address) 4170 /...i.,.co/fr►l 7rt. 1-e i Edtnh AAA)
TYPE OF WORK ❑New Construct n ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding
['Addition Alteration ❑Utility Connection g ['Lower Level Finish ❑Fireplace
CODE: DI.R.C. DI.B.C. 0 Misc. _ _
Type of Construction: I II RI IV A B PROJECT COST/VALUE $ 6raC)
Occupancy Group: ABE F HI M S U i
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have banished information ot},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. structi,,,.�1.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 • it for ust se. Fu,rermore,I hereby agree that the city officiali� or a designee may enter upon the property to perform needed inspections.
X _. !J66,?b3SaZ r-/3
Signature Contractor's License No.
Date
Permit Valuation ct app Park Support Fee # $
Permit Fee $ / 2 SAC ## $
Plan Check Fee $ .g' - i 3 Water Meter Size 5/8"; 1"; $
State Surcharge $ / Ob 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 $ I Q / /C)3
•
This Application Becomes Your Building Permit When Approved Paid Ziq .to 3 Receipt No.(7a2A9
C / 5Date �12$r(# 5 By '�L�
2� 1�
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
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