HomeMy WebLinkAboutBuilding Permit #12-0555 � O❑� n D OOO❑ = O Q Zn
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� 9 CIT'Y` 4F PRIOR LAKE BUILDING PERMIT, �dt �'r�
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" �'' AND UTILITY CONNECTION PERMIT � ?" � �
�
r �'NE5��
� wh�u File PERMIT NO. / 2
2. Pink City
3. Yellow Applicant
lease or ' and si at bottom
ADDRESS ZONING (oe'ice use)
J3��2 f� '� �, , 5(�
LEGAL DESCRIPTION (office use onty)
LOT BLOCK ADDITION PID
(Na e 1J �0 �''l 1 Wl S (Phone) -\� 2` 6 2�' G� b�
(Address) 3 U 1` �'(` � J- J Vv
BLTII.,DER �` � J �+ Q�
(Company Name) ^l �1 I" t � d� �� l � (Phone) V � Z 0�� "��GZ
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(Contact Name) G �1 (Phone)
(Address) 2 rJ �- ( 1 � � � Q�
TYPE OF WORK ❑ New Consmiction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addidon �fAlteradon ❑Utility Connection
CODE: �I.R.C. ❑I.B.C. � Misc: �� � ( � ��/1�
Type of Constmction: I II III IV V A B �*
Occupancy Gmup: A B E F H I M R S U PROJECT COST/VALUE S ' SVV
Division: 1 2 3 4 S (excluding land) '
I hereby ' that I have fumished information on this application which is to the best of my knowledge aue and correct. I also certiCy that I am the owner or authorized agent for tbe
above- floned properry and that all constiuction will conform to all existing state and local laws and wili proceed in accordance with submitted plans. I am aware that the building
offi ' revoke this p�nit for just cause. Furthermore, I hereby agree tliat the city official or a designee may enter upon the property to perform needed inspections.
� \
X ac6o�o�� �-�-iZ
Signariue 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 8c Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLTE $ �—
Tlds Applicatioa Becomes Yo�u� Buildin6 Permit When Approved Paid Re ' t No.
Date • �� B
Buildin Officia! Date
This is to certify that the request in the above application and accompanying documentc is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner rnnsfltutes a temporary Certificate of Zoning rnmpliance and allows rnnstruction to rnmm�ce. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditiaea, if �y
, 24 honr notice for rll inspecHoas (952} 417-9850, fax (�S2) 449-4245
4646 Dakota Strcet S.E., Prior Lal�e, Minnesota 55372