HomeMy WebLinkAboutBuilding Permit #12-0808 � ❑ �� C'� ❑ ❑�O❑ _ � o =�
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o � eR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��3 j�
.. � AND UTILITY CONNECTION PERMIT
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�IN I. Whi�e File PERMIT NO .�� - (J ��
?. Pink City `�
3 Yeliow Applitam
Please or rint and si at bottom
ADDRESS ZONING (ott�ice use>
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LEGAL DESCRIPTION (of£ice use only)
LOT BLOCK ADDITION PID
OWNER . f �� _ �Y'
(Narne) �j � ��.�/Y (Phone) ��
(Address)
��c� � �� o�K Sr: s, � ��3�
I BUII,DER �.Ti�nlL� l�Z— YJ �' I�L �� R S C. (,� lp �� � l G S� �
(Company Name) (Phone) � �'""
(Contact Name) ���C Cl Z-- (Phone)
(Address) l �' �- �'- � Sf �.�-- �� p�l� 1 �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch -Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireptace
❑Addition ❑Alteration ❑Uality Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constiuction: I II III IV V A B pROJECT COST/VALIJE S
Occupancy Group: A B E F H I M R S U (exciuding land)
Division: 1 Z 3 4 5
I herrby ceniCy that [ have fumished infvrmation un this apptication which is ro the best of my knowirdge true and correct. I also ceitify that I am the owner or authonnd agent for the
above-menhoned proprrty and that all construction will conform to a(1 existing sWte and local laws and wili proceed in aceordance with submitted plans. I am aware that the buildmg
utl'icial can revoke t ermit fo cause ��more, I hereby agree that the ciry officiai or a designee may enter upon the property to peiform necded mspections.
X ( �^ / 3 —� �—
Signature Contracror'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 $
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Tltis Application Becomes Your Building Petmit When Approved Paid ' Re i t NO.
Date . � Z�. B
Buiidin � Utticial Date
Th�s u ta certify that the requcsc in the aiwve appticahoo and accumpanying documenis is in accordance with the City Zonin� Ordinance and may procerd as requ�xted. Th�s document
when sigrred by the Ciry Pianner cunsututcs a temp�rary Certificate uf Zoning compliance and allows construction to commence. Before �xcupancy, a Ceraticate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for ali inspections (952) 447-985(i, fax �952) 447-47AS
4646 Dakota Street Prior Lake, MN 55372
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