HomeMy WebLinkAboutBuilding Permit #12-1122 y ❑❑� C� ❑,P�O[70❑ � O D ZA
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oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
v � AND UTILITY C4NNECTION PERMIT ����✓ �
� �
�' 1 Wfii�e F��e PERMIT NO. �� -`���
Z. 4ink City
3 Yellow Appiicant
Please or rint and si at bottom)
ADDRESS ZOI�TII�TG (ot�ice use�
3� 7 ' S� � ss
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER-�- � l F�� t M c. �
(Name) � 12.55� C-�.- r C=�i.r� � Z(��6 � �=- (Phone) �J d� 'y `� �.S 7 7 0
(Address) Sa,,..e_
BUII,DER I , 1
(Campany Name} CU.lS �rt u-c��o�-�. 1�C. • (Phone) ��� ��U� SO�
(Contaet Name) �t�-+� S (Phone)
(Address)13y 3� Ge� r!a— (/U" � � � % a �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch [i�1�ie;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 1V V A B pR03ECT COST/VALLTE $`��- �
Occupancy Group: A B E F H I M R S U
(excluding land)
Division: t 2 3 4 5
1 hereby certify chat I have fumished information un this apptication which is to [he best of my knowledge tn�e and conecc I alsu cerufy tha[ I am the uwner or authurixed agent far the
abovr-menhoned property and that all construetion will conform ta all existing sta[e and local laws and will proceed in accordance with submitted planx. I am aware that the buiiding
uf'Ficial can revuke this pei mSt for just cause. Furthermore, I hereby agree that the c�ry offiriai �r a des[gnee may enter upon the property tn pc�form necded lnspectiuns.
X � r�-- �c_ 3�/ 3�� 7 9�-��
Signamre Contractor's License No. Date
Permit Valuation � Park Support Fee # $
Percnit Fee $ �� SAC # $
v
Plan Check Fee $ Water Meter Size S/8"; 1"; $
State Surcharge $ S Fressure 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 $ .'7S
This plicadon Becomes Your Building Permit When Approved Paid ReCei t No
� �� Date - B
Buildine t?t�icial Date
This �s ro certify that thc requcst in [he above applicanon and accumpanying documenis is in accordance with the Ciry Zoning Ordinanct and may proceeA as rcqucsted. This document
when signrd by the Ciry Planner conshtutrs a tempurary Certificate of Zoning comptiance and allows cc�nstruction tu eommence. Befure uccupancy, a Cerhticate uF Occupancy must be
issucd-
Ptanniqg DiteMOr Date Special Conditions, if any
24 hour noticc Lor a4f inspecteons (952) 447-9R50, i'ax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372