HomeMy WebLinkAboutBuilding Permit #12-0676 � ❑❑ I� (� O`� O � O O � O > Z c?
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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� X AND UTILITY CONNECTION PERMIT
U �
��NNES��� �. Wh;�e File pERMIT NO. y .y
2. Pink City / � �j /�y
3 Yellow Applicant �
(Please e or rint and si at bottom)
p � D�� $ � � � ZOIVING (office use)
s � .�� h CJ
LEGAL DESCRIPTION (ofI'ice use onty)
LOT BLOCK ADDITION PID
O aWrNER Vv 01� fd/►� � � �i I �� � ��/ � (Phone) � �2� 2 Z � ls �� �
(Address) l 5�/� �i� N 1 Gr� ✓'
Bi.TILDER A � � r''�� � � 7 U' �� 1 � �D3� �Z � � _(D �b
(Company Name) 1 v r � � S (Phone)
(Contact Name) �1 G� �" �' �I � (Phone) �i �Z 7G�2 � �' �
(Address) �� � �j y �A ""�"1r � C � ✓ �'
TYPE OF WORK ❑ New Consauction ❑Deck ❑Porch �Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $ �v �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that f have fumished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the uwncr or authonzed agent for thc
abuve-ment�oned prope�ty and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enrer upon the propercy to perform necded mspections.
X�'�,,�— �-�/ f� C n I o2 ��- bl Zs'� i Z
Signature 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 DUE ��!� 1�
This Application Bec.omes Your Building Permit When Approved Paid Recei t O.
Date Z B
BuilJina Utlicial Date
This �s ro certify that thc requcst in the above applicauon and accumpanying documents is in accordance with the Ciry 7.�ming Ordinance and may proceeA as requested. Thls document
when signed by the City Planner constuutes a temporary Certificate uf Zoning compliance and allows constniction to commence. Before uccupancy, a Cerhficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372