HomeMy WebLinkAboutBuilding Permit #12-0692 3 ❑ O� C� ❑OOO � O D yn
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F vrt� CITY OF PRIOR LAKE BUILDING PERMIT, � Date Rec'd
��°" "� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�' � AND UTILITY CONNECTION PERMIT �' � Z ��L
U �
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M�'�'NESO�P I. White F��e pERMIT NO. �� ���`
2. Pink City
3 Yellow Applicant
(Please e or rint and si at bottom)
ADDRESS ZONING (o�ice use)
� � � l � , 1 �I � �-�c� � ss
LEGAL DESCRIPTION (office use only) `�
LOT BLOCK ADDITION PID
OrWNER (�,,, �'J m � � �"1 l.11�' (Phone) ! �a' 0�0 '� � �
�.>
(Address) � / � � ��' 1 �S
BUII.,DER � a5a - G �5 - - ►aa6
(Company Name) �G- � no� cxo c�:� \{2�rtyoc�laa: c`� _ _ (Phone)
(Contact Name) �eo-rnc, l t\ic� (Phone)
(Address) �Q 1 n� F,�c(A-\59 c��C' 1 -� .� �S rsvK 5�'J�I �Co
TYPE OF WORK ❑ New Consrruction ❑Deck ❑Porch �Ite-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/VALLTE $ U�' ��
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fiimished information on this application which is ro the best of my knowledge tnie and correct. I also certify that I am the owner or authonud agent for the
above-mennoned property 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 building
official can voke this permit for just ca�. Fu� re, I hereby agree that the ciry official or a designee may enter upon the property to perform needed mspections.
X .J�-�.r� C� rz.r�� c� s d � 1�`� 1 ��--
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 DiJE $
This Applicarion Becomes Your Building Pernut When Approved Paid � R 1 t N
Date t/
Buildina Ufticial Date
This is to certify that the request in the above application and accumpanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy a Certificate of Occupancy mus[ be
issued.
Planning D'uector Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372