HomeMy WebLinkAboutPlatform Permit 13-42 o 4 PR7 CITY OF PRIOR LA : UILDING PE '4 IT, Date Recd
,� TEMPORARY CERTIFICATE 2 ONING CO PLIANCE c
AND UTILITY CONN ' °': -' IT 2S Z Z. 13
y r�Nt3gO� h 1. White Pile
2. Pink city PERMIT NO. /3 L
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ i q .; 3& file Oxus- - A- E.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 05 — (0i — CV�]- 0
OWNER c
(Name) S et k S-1- v (Phone) % S2 . 2 1 57 14 y
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ❑Deck ❑Porch DRe- Roofing DRe- Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ['Utility Connection _
XMisc. p/ f / � f X (3 /
CODE: DLR,C. DLB.C. Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify t I ave furnished informat : 7n 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- mennone. pr.. •rty and that all cons is '.n will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can rev is permit for lust cause - rthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed spccti ins.
l3
- 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 $
f15 ,
Gas Fireplace Permit Fee $ TOTAL DUE $
1
This Applica off: - omes Your Building Permit When Approved Paid Receipt No.
,, tf l
..7. . (3 Date By
131.0 ring Official Date
This is to certify hat the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447- 9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372