HomeMy WebLinkAboutShed Permit 13-65 04 Piti CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0 , , TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 1 t0 . f U I-3 , �
70 AND UTILITY CONNECTION PERMIT
4 4xesoi'' t. White File
2. Pink City . PERMIT NO. /3 . 5
3 Yellow Applicant
sttype+aLp and sign at bottom) ��
ADDRESS ZONING (o / 41 V .7 0 / (/ / t' � % ice use)
LEGAL DESCRIPTION (office use only)
1 /�
LOT BLOCK ADDITION PID 05 -- .X�J �"J10
O . /
(Name) E L \/ ✓ r.::. 'hone 233 403- 7 7o2 0
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch DRe- Roofing DRe- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection )
CODE: DLR.C. DI.B.C. )(Misc. - k G C ( mi / ) ed
Type of Construction: I II III IV V AB
° ° °° PROJECT COST /VALUE $
Occupancy Group: A B E F III MR S U
Division: 1 2 3 4 5 (excluding land)
1 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 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 can revoke this • it for ause- ftlrthermor ereby agree that the city official or a designee may enter upon the property to perform needed Inspections.
X / ' —L_ td ' 6 -- / 3
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 $
,0 Gas Fireplace Permit Fee $ TOTAL DUE $
T ' plication Becomes Your Building Permit When Approved Paid n /6 - Receipt No.
r 0 / 6/ Date By
Building Official Date
This to ce ify 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
whc sign . by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issue ..
C---. . - 1 .. 411" ..6. — 1 - . --- C - )\ 4 3' /O)/6)/..
P / ning ) irector 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