HomeMy WebLinkAboutBuilding Permit #12-275 y 0 0� C� O`9'� O �❑ � O D N c�
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, l;l'1'Y UN' YK1UK LAIi� 13U1Lll11V(i Y�KMl'1', llate ec d
�� �i \�� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" '�___� �' AND UTILITY CONNECTION PERMIT
�
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'. "'h'� F"e pERMIT NO.
2. Pink City � . •
3. Yellow Applicant � — � . .
Please or rint and si at bottom
ADDRESS ZONING (ottice use)
1`�IB� �6��,�on ��o.�.l S.E .
LEGAL DESCRTPTION (o#Tice use only)
LOT BLOCK ADDITION PID
OWNER \
(Name) 0..'h �Q.'R SO n (Phone) � o� ' yy� -' o�� 9�0
(Address) �
BUII,DER " Renewal By Andersen
(Company Name) 19Z0 County Road "C" West (Phone)
(ContactName) Roseville, MN 551Z3 (Phone)
(Address) License # BC130983
651-264-4777
TYPE OF'WORK ❑ New Construction ❑Deck []Porch �Re-Roofing �Re-Siding [�Lower Level Finish ❑ Fireplace
�Addition �Aiteration ❑UtilityConnection ��� � L���S ��N
CODE: �I.R.C. DI.B.C. ❑ Misc: yQ.lY. � .� 1(��•
Type of Constzuction: I II III IV V A B p O�?
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $� � S� /
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furniched informaflon 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-mendoned property and that all construction will conform to all ea�isting state and local laws and will proceed in accordance with submitted plans. I am awaze that ffie building
ot�xcial can r vo� r�ust cause. Furthermore, I hereby agree that the ciry official or a designee may enter upon the properry to perform needed in4pections.
x ���`���'i�.2 �� � 3�� . l0 �j f i � Z.
Signature Conlractor's License No. Date
Pernut Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
Staxe 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 $ •'J ;�' ;`
This Application Becomes Your $uilding Permit When Approved Paid " i r Rec � t No. ' _
�,
Date - ' B
�
Buildin Officiai Date
T'his is to certify that the reques� in the above application and accompanying documents is in accorda�e with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Ceitificate of Zoning compliance and allows construction to rnmmence. Befure oocupancy, a Certificate of Occupancy must lae
issued.
Planning Diredor Date Special Condi6ons, if any
24 hoer notice for all inspections (952) 447-9850, fax (952) 447-4245