HomeMy WebLinkAboutBuilding Permit 16. 0258 a O O 0
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PR-1 ,6-ICITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �y /�
AND UTILITY CONNECTION PERMIT `
HEgO�� I. white File PERMIT NO.
3 Pell City / ��Q •
3 Yellow Applicant LQ U
(Please type or print and sign at bottom)
ADDRESS
ZONING(office use)
l G 93 Z a/4- Uw 1H i ;)..... 14,E
LEGAL DESCRIPTION(office use only)
LOT 13 BLOCK ADDITION -r-
A e Wilds PID 5 7 t >—7
Name)R it/14v' k 4, 1o.-5 (Phone) f J 2( - f'0-,238s
(Address) 1 V6 9' 3 it); /4 !/4ts // /45;"l'aw ' k"
DER
(Co ,✓f it , `
(Company Name) � • ,( (Phone) fp/ 3(.217-25/
(Contact Name) W ep,t/} (Phone) 6/43V 4 7 .25/
/
(Address)&) S1,5.. G i yr Lv.3�d ei ,,,,,,441,,,,-, ) 14,
TYPE OF WORK 0 New Construction VeSo eck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
['Addition ❑Alter on ['Utility Connection
CODE: ]I,R.C. ❑I.B.C. 0 Misc.
Type of onstruction: I II III IV V A B /6,°°°
•�'pV b
Occupancy Group: ABE F HI MR SU
PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official�� i�� ust C- . Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No.
Date
Permit Valuation �.5p �c Park Support Fee # $
Permit Fee $ t 7 Z, .4 ( SAC # $
Plan Check Fee $ 7 —S-10 Water Meter Size 5/8"; I"; $
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 4".S. b 10 $ 4i-,✓ ?t,
This A, at+, Becomes Your Building Permit Whe Appr ed Paid //St /� Receipt No. gooz_
.. .._
Date By
Bu D.to
This is to cer' that t•e request in the above application and accompanying docu encs is n accordance with the City Zoning Ordinance and may proceed as requested. This document
when signe.j° the y Pias er constitutes a temporary Certificate of Zoning c plian and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued �� �< <
e 404W r
/ S` (6.
Planning • - . Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
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