HomeMy WebLinkAboutBuilding Permit #12-317 � O❑ j(j. n O�( O O O❑ � O D Z c�
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LEC'rA_�. D�SCRyb'�OIV (oft'ice use only)
LOT BLOCK ADDITION PID
O�'VNER
(Name) C��n/ lL u a.r N 1� A-�.F� �
(Phone)
(Address) �j��
BUIi.DER
(CompamyName) S P/L1�(r�-1Z- .aS�u o,.� S y,�v`G�g (Phone) __9s Z—y'/O—/9�7
(Contact Name) �/,�wN` s � u,/t-a 5
(I'hone) _ �,g�-
(Address) , O. �ols �7 �2 /�-./ S 3 7 Z
TY�E O� WORaK ❑ New Consuuction �Deck ❑Porch �e-Roofing ❑Re-Siding ❑Lower I,eve( Finish ❑ Fireplacr
❑Addition ❑Alteradon ❑Utility Conne ion ❑ Misc.
• CODE: �I.R.C, QI.B.C. PROTECT COST/VALLIE $_1(' �,�
Type of Construction: Y II YSI N V A B (excluding Iand) '
Occupancy Group: A � E �' H I M R S U
Divinion_ 1 2 3 4 5
1 hcr�by certify thac f have furnished information on thic application which u to thc bcsr of my knowledge we and correct. 1 also cenify that 1 am thc uwncr ur authorizcd agcnt for che
above-menno ropetry and thac all conscruction wi11 conform to alt cxisting state and local ]aws and will proaed in accordance with svbmitted plans. 1 am awarc that chc building
oEFidal c rcvok this permit f 1usc cause. Futthcrmore, I hereby agrcc thac thc ciry ofl'icial or a dcsigncc may entcr upon thc property to perform nccded inspccti�ns.
X ��-- ���,� zl s y �� � i, Z
Signacure Coninctor's License No. Date
Perinit Valuarion Park Support Fee ## �
Permit Fee $ SAC # $
Plan Check Pee $ Water Meter Si2e 5f8"; I"; $
State Surcharge $ Pressure Reducer $
penaltY $ SewerlWater Connection Fee # g
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Pee $ Builder's Deposit g
Sewer & Water Permit �ee $ Other ' $
Gas Fireplace Permit Fee $ 'I'OTAL Di7)E g
. 7 � �S
This Application Becomcs Yout Building pernvt When Approved Paid Z 2 Recei c No. Z'2
�—_—"� �6 �2 Date /6 / B
Buiidin Uf?iciai Dat
Ttus is to Cettify that the Cequest in the above apptication and accompanying documents is ia accordance with the City Zooing Ordinaner and may proceed as requcsted. This document
whrn signed by the Ciry Planner conscituces a remporary Certificate of Zoning compliance and apows conswction to commence. Before uccupancy, a Ccttificate of Occupancy must bc
issued.
Plan�ung D+Tectrn' Date Special Conditions, if any
24 hour notice for aii inspections (952) 447-9850, fax (952) 947-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372