HomeMy WebLinkAboutBuilding Permit #12-304 � �❑� C� � , 0��❑ 'o O D ZA
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o � PRJp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ,�. Z3 ►�
.. � AND UTILITY CONNECTION PERMIT
U �
'I�jNNESO�t' I White File pERMIT NO.
2. Pink City � • � C � �
3 Yel�ow Applicam
Please or rint and si at bottom)
ADDRESS ZONING �of�ice use)
��`7 S / a�� s I � c,,,./
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER './ '`` /` �/f�
(Name) �- Q//L1 VV�(`I'1�� �h ��rC. k�w (Phone) b �2 " '(1 D ' O 7 � 6
(Address) � l9� � �� f 7' _ inJ
BUII.,DER /� �I SL — �f y7 "� I S��
(Company Name) ►''� �--o✓'� � (Phone)
(Contact Name) L' .S-� (Phone)
(Address) �o `( 4 . �. ! 11r
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �'Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udlity Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certity that I have fumished information on this application which is to the best of my knowledge true and correct. 1 also cenify that 1 am the uwncr or authonzcd agent for thc
above-mennoned property and that all cunstruction will conform to all existing state and local laws and will proceed in accordance with submittcd plans. ! am aware that the buildmg
official can revoke this per 't for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necdcd mspections.
X R��`f1 � 1 �l - z�-12
Signatur 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 $ s
This Application Becomes Your Building Permit When Approved Paid ei t NO. ,�
Date y .
Buildin � Ufticial Date
This �s to certify that the requcst in the abuve applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. Th�s ducument
when signed by the Ciry Plannrr consumtes a trmporary Ce�tificare of Zoning compliance and aliows construction to commence. Before uccupancy, a Certrticate uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372