HomeMy WebLinkAboutBuilding Permit #12-1347 � ❑ ❑ O n ❑ ❑�OO � O > Nc�
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o � PRtp� CITY OF PRI4R LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
v �' � � l�
���'NEB��� 1. White File PERMIT NO , l j�
2. Pink City r .
; Yellow Applicam �T ( �7 / �
Please or rint and si at bottom)
ADDRESS ZONING (utTice use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O a WNER � / � �''� I��G'C�w�S
) t-u.��. (Phone) �(Z � �`l�' �7��
(Address) �!� �Q ��-s/'S 1�..i' J �Yt�'� s - l�. ��"�'.� C..�„�c,�
BIJILDER �,� � � (..�/y�S� "� ""�' ���
(Company Name) �- 'r< < ,S� � (Phone) `� �' � � � �
(Contact Name) �� `� (Phone) -S+'�e—
(Address) Z-� 7 31 � � � �w��+^ � �S.S-sZ
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch +�s-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alterariott ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. C1 Misc.
Type of Constiuction: I II III IV V A B PROTECT COST/VALLTE S �P� '�"
Occupaney Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
! hereby certiFy that i havr lumished information un this application which is to the best of my knuwiedge crue and correct. I also certify that 1 am the owner or author�zed agent fur thc
abuve-menhoned property and that all cunstruction wiq conform to aA exuting state and local laws and will proceed in aceordance with submitted plans. I am aware that the buildmg
ufficial can r i �mrt for just use. Furthermore, I hereby agree that the ciry officia! or a designee may enter upon the property to perform necded mspections.
X ������'^"' '(�,' �'rJ ZJtY�`� � � " Q� � v `.
Si amre Contractor's License No. Date
Permit Valuation ' Park Support Fee # $
Permit Fee $ *7� '7 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 $ "� . 7�
Ttris Apptication Becomes Your Buiiding Pem�it When Approved Paid L ReCei t NO.
Date — B
Buildine Ut�icia��� Dat
This rs to cercify that thr requcst in the abuve application and accumpanymg documents is in accordance with the City 7A>ning Ordinance and may proceed as requcsted. Th�s document
when signed by the Ciry Planner constuutes a temporary Certi6cate of Zoning compliance and allc>ws consmiction to commence. Before �xcupancy, a C�7uticate �>f Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for ali inspections (9S2) 447-98 +(I, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372