HomeMy WebLinkAboutBuilding Permit #12-425 � O❑� C� ❑ ❑00❑ � O D NA
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oF 1*Rlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � l�r ��
� �
AND UTILITY CONNECTION PERMIT
�
'�j�yNESO�t' �. wh;�e Fite pERMIT NO. �.
2. Pink City
3 Yellow Applicant "
Please e or rim and si at bottom)
ADDRESS ZOI�TING (ot�ei�e use>
/ 7 j q� (,c,� o o clv �¢ w �-�. 5 rr'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
ovvlvEx �� � L��� G b o•� S 0�
(Name) Y �d � � 5 (Phone)
(Address) I 7 � Q 0 � 0 n �1/� ( ,� �j �7 S �
BUII..DER Pella Northland y s� j3 y s • G b 4 7
(Company Name)_ 15300 25th Ave N. Ste 100 (Phone)
(Contact Name) _ plytnouth, MN 55447 (Phone) R J a�/
(Address) Lic # BC645090 Ph. 763/745-1400 '�� �''�<<� �'� �`�-�'`� . ��G'
TYPE �F WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding '` ❑Lower Level Fin�ih ❑ / Fireplace /
❑Addition ❑Alteration ❑Utility Connection (p (,,,� �!� (( �p (,Jl� r l ^t^f 0/1'7" �Tf y
CODE: ❑I.R.C. ❑I.B.C. ❑ M;sc. d 0 0 l' r��,G�.( M.l � �
Type of Construction: I II III N V A B pROJECT COST/VALUE $ � i 3 q J
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I h�reby certity that I have fi�mished information on this application which is co the best of my knuwledge true and correct. I alsu certify that I am the �iwner c�r authoriud agent for thc
above-menuoned propeity and thac all c scrnction will conform to all existing state aod locai Laws and will proceed in accordance with subminrd ptans. I am aware that the buildmg
� uffcial can revoke this per t for t cau uYhermore, I hereby agtee that the dty officiat ur a designee may enter upon the property to perform necded mspectiu s.
s�e r�
Signature Contractor's License No. Date
Permit Valuation � SZ�7 �;� Park Support Fee # $
Fermit Fee $ '7 � SAC # $
Plan Check Fee $ �_ Water Meter Size 5/8"; 1"; $
State Surcharge $ — D 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 DiTE $ '� �• S
This Application m�es Your Building Permii When Approved Paid .�1 ei t No.
,,, Date � t-
�" � �
Buildim� f ia Dat
This �s to certify that th requcst in the abuve applicat�on and accompanying documents is in accordance with the City 7aroing Ordinantt and may protted a� requcsted. Thls document
when signcd by the City Pl�nner consatures a tempurary Certificate uf Zoning compliance and allows construction tu commence. Before uccupancy, a Cer[iticate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for alf inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372