HomeMy WebLinkAboutBuilding Permit #12-1378 3 ❑ O� C� O�O�O❑ � O D yc�
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o � PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� 9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE `/�' � G�. ��
� � AND UTILITY CONNECTION PERMIT
�
~tNNES��� l. Whi�e F��e PERMIT NO / Z !� �
?. Pink Ci1y
3 Yellow Applicanl � / V �
Ptease or rint and si at bottom)
ADDRESS ZONING �o�e��� uSe�
` v�ti q � r o v. Src. �; �. 1�.1 . W• � r: o a, Z�..iGs. .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
{Name) �u� � �'�L� (Phone)
(Address)
BIJII,DER
(Company Name) `N % ��*Y+� �.t. (Phone) °� `� z ' � � 2 - �b `t o r-/
(Contact Narne) C-�+�•-�� G ��„� (Phone)
(Address) . l �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Conn tion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pR07ECT COST/VALLTE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 S
1 hereby certify that t have fumished information on this application which is to ihe besc of my knowledge tnie and correct. I also certi(y that 1 am the ciwnrr or authonzed agent for the
above-menuoned property and that atl cunshuction will confurm to atl existing state and tocal laws and will proceed in acco�dancr with submitted plans. I am aware that the buildmg
ufficial can revoke this permit for�usc cause. Furthermore, I hereby agree that the c�ty officiai or a des[gnee may enter upon the property to perform necded tnspc:ctions.
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t1- IR-'Z 0�2.
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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 DUE $
�
This Appticallon Becomes Your Building Permit Whrn Approved Paid ece' t No.
Date (
Buiidin � Utlicial Date
This is to certify that the requcst in the above applicauon and accumpanying documents is in accordance with the City ZAining Ordinanee and may proceed as requc�sted. This dexument
when signrd by the Ciry Planner eonsututes a remporary Certificate of Zoning compliance and aUows consmuction tu eommence. Before cxcupancy, a Cerntialte of Occupancy must bc
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S?) 447ASS0, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372