HomeMy WebLinkAboutBuilding Permit #12-325 � O❑� C� O�❑00 � O D Zc�
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Q � pRl , C�TY O� PRIOR LAKE BUILDING PERMIT, Date Redd
� � TEMPO AND C UT�IZ T �� CONNECTION PERMiT LTArICE �� .��
U h .
��NNES�� . . t. tYhrte f➢le
- 2. �,: � PERMIT i�IO. „�jZJr' �
3 Ydbx AppGoet �
Iease or rint and si at bottom
ADDRBSS - ZONING (ott'm uscy
1\ rov�.s� C�r�\
LBGAL DESCl2II'TION (ofl�ce use only} �
LOT BLC.�CK ADDITION � PID
(I`ia�� v � (Phone) "t 117 "�4.� � � 7 .
(Address} �, . �; ` �,�,1�
BI7ILDER
{Company Name) .�r'i Ck SOn �U I � a�i n a r1 C: (Phone} b S� a� �� - 93�
{Contact Name) _ LeG � r% c,rCS0r1 � (Phone} b Sj - aOb - 13 9�
(Address) v 76( 5� �!Z')1/E' l��Ge.l,' p 1� SCS'/ o�S
TYPTs OF WORK ❑ New Construction []I}ecic �Porch -Roo6ng �Rc,Siding �I.ower i.evet F'mish ❑ 8'ueplaae
DAddition pAiteration pUtiliry Connection
' CUDS: [jI.RC. �I.B.G � M's�- -
Type of Constiuction: I II IIT N Y A B
Occapancq Group: A B E F H I M R S II FROdECT CflSTIVALUE �
. n�yis,on: � 2 � a s teacci�afng �ana) .
I 6aeby attify that i have Wmishe� infmmatioa on this a�1� wLieh is w the best of myknowlod� riue aad cnarett. I aho cettify that ! am the uwner ar aotha�izcd agcnt for the
abo�meMioaed a Uwt ait m�tnuYwn will confo.m ro ail existing state and loca! laws and w�1! pmoced in aaordana wuh wbmitied ptans. t am awate that t6e bnilding
oflice[ can t6is pe f�just caus 'J henby a�ee tbat tGe city ofTidai �a daigaee emy aNer np�m the p�openy eo pertoan nccdcd iruprctions.
X � � SC�9sva9 y-ao--��
--- ' Signature Contracto�s Liccnse No. Date
Permit VaInation Park Support Fee # S
Permit Fee " � $ SAC # $
Plan Check Fee $ � Water Meher Siz� 5/8°; i"; $
State Surcharge S Prrssure Reduoer S
Penalty $ Sesver/Water Connectioa Fee # � S
Plumbing Permit �ee " S Water Tativer F� # $
Mec6anical Pesmu Fee S- Buiider's Deposit S
Setver & Water Permit Fee �' S Other $
Gas Rireptace Peimit Pee � TdTAL D�3E S
This Appiication Eeeomes lrarcaulld4ag Pmn�c Whea A�P�� Paid — t No_
• Date B
Buitdin ORicin! Date
17��s is to canfY that the request in tbe sbovr a�licuioo and a000a�nryiug �ncats is 6t aeeo[dana uieh tlrc C'ttp Zwibg Ord"i�oance.and maq pmcoed at �oad. Tleis ducu�nt
whcn si�o�cd by 1he C'ity PianMr cmnsfitma a tempuiary Cc�e of Zonmb compi'iance �d afb�wt consw�ia► to oomaKqce. Befusr oeayvaey. a Cc�tc uf Oacapaa�y must be
issetd.
Dirator " Special � an
?r4 hmp' asfiec for ail ipspcctloas (9S2} N7-48Sd. !ax (9S2) 4t7-42ii" .
4646 Daioota Street P� Lak+a. MN 55372