HomeMy WebLinkAboutBuilding Permit #12-507 S❑❑ n O���O❑ � O D =n
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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT
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1. White File pERMIT NO .
2. Pink City � z �
3. Yellow Applicant
lease e or rint and si at bottom
ADDRESS .. ZONING (ot�ce use)
33 � g t�ti l ��s � ss ��J P���� L�� 5 s��z
LEGAL DESCRIl'TION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) �v � `d► � ��e�� (�2p �� (Phone) ( � 2 , 3k' S . l6 Z �
(Address} 3 ? J �o g � ti L � �� � ` � �j (�'�. (U 5 , 3 7
BUII,DER
(Company Name) ��E � C'��s�►v� �w� t� (Phone) �1. �-ri 2 �Sg ? �2D�
(ContactName) (Phone) 1�i,� 1Z zbQ — ��j!
(Address) 3� Q � T zV � �j 1 qp yh t rL (�'�, s •�.3 1
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding �Lower Level Finish ❑ Fireplace
DAddition �]Alterarion ❑Utiliry Connection
CODE: �I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B /
Occapancy Group: A B E F H I M R S U PROJECT COST/VALUE $��. Q�1�� �_
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fitrnished inforniadon 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 property and that all construction will conform to a11 existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can evoke this pe 't for just ca e. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x F�t_ I( 4�(j Z 5 /'�
i 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 DiJE $
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This Application Becomes Your Building Permit When Approved Paid Recei NO
Date B
Buildin 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 Occupanty must be
issued,
Planning Director Date Special Conditioas, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
� � 46 �,�o`� S S �