HomeMy WebLinkAboutPlatform Permit 13-04 oI "to CITY CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
o TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
V A N D UTILITY CONNECTION PERMIT
U rtj
iNNEsel" 1. white Fite PERMIT NO
2. pint: City 6/ e( -
3 Yellow Applicant_ 1
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ &cif ki4e iii VE aor Lae Mail
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID d ' t0? l - 0 1 J
OWNER (( ',t n
(Name) ....1 �h.� �� � V !. aro r t.--. (Phone) ! SZ
(Address) . 5011[ .45 /40J
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe- Roofing ORe- Siding OLower Level Finish 0 Fireplace
DAddition DAlteration DUtility Connection
CODE: DLR.C. DI.B.C. Misc. PA k- -N\ `Z` `[ ) �}
Type of Construction: I II MTV V AB T/VALUE
Occupancy Group: A B E F HI MR S U PROJECT COS $
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 1 am the owner or authonzcd 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
A ...... official can revoke this permit for just cause- Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X q Iii.„ vc ° 4--3 oB • o c'D 1 -2,7
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 $ l Gas Fireplace Permit Fee $ TOTAL DUE $
This plication t t m Your Building Permit Whe Approved Paid Receipt No.
/ Date By
/r . ..i�Q� 4 IS ! 3
Building Ofticii D te
This is to certify that 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