HomeMy WebLinkAboutBuilding Permit #12-0983 y O❑� n O�O�O❑ o � v Z�
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oF eR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ,� TEMPORARY CERTIFICATE QF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT c��r�
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4�pN68���' �. wn��e F�ie PERMIT NO . (�.— �� �
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3 Yellow Applicant ,
Please or rim and si at bottom
ADDRESS ZONING (ot�'ice use>
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LEGAL DESCRIPTION (office use only)
LOT BL�CK ADDITION PID
� � � � � �gY`I GS }�.✓ (Phone)
(Address) Shn��
UII,DER /J / .
Company Name) �m�i,Ci,a .�1� (Phone)
(Contact Name) ,ge � C,�IiGK.�L. (Phone) �tl� '70 3���fqv
(Address) �S � ,5��
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing �e-Siding ❑Lower Levei 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 S
Occupancy Group: A B E F H I M R S U
Division: 1 Z 3 4 5 (excluding land)
1 hereby certify that I have fumished infi�rmation on this appiication which is to the best of my knowledge mue and conect. i also certify that I am the ownc7 or authonzed agent for thc
� above-ment�oned property and that alt construction will conform ro all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
( ufficial can revoke this permit for just cause Furthennare, I hereby agree that the city official or a designee may enter upon the propetty to perform nrrdcd incpections.
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Signature Conuactor's License Na Date
Permit Valuation -Z � � � � 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 $
.
This Appiication Becomes Your Building Perntii Whea Approvtd Paid Recei t NO.
� C ��� 2 � G � �_� � Date — B
Buildine Ufficial D�te �
This u to certify that thc request in the aiwve application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed is requ�sted. T'h�s d�xvment
when signed by the City Planner cunstitua�s a tempurary Certificate of Zoning compliance and aAaws cunstruction tu commence. Before �xcupancy, a Cc�•uticau nf Occupancy must be
issurd
Pianning Director Date Special Condidons, if any
24 hour noticc for ali inspections (952) 447-985(1, fax (952) 447-424,5
4646 Dakota Street Prior Lake, MN 55372