HomeMy WebLinkAboutZoning Permit (platform) 10-0016 oF PR/�� CITY OF PRIOR LAKE BU IT, Date Rec'd
,� � TEMPORARY CERTIFICATE ZONING CO PLIANCE ��3 ��
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M��'NES��P � Wh,�e Fde pERMIT NO. �
2 Pmk Ciry .�
3 Yellow Applicant
Please e or rint and si at bottom �
ADDRESS � ZONING �ott'ice use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 2- � a-� � 0�• U
OWNER
(Name) (Phone)
(Address)
BUILDER Q 1
(CompanyName) (Phone) I�tf-`a �S'6
(Contact Name) C�h FC (Phone)
(Address) a. �//�',����
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Fmish ❑ Fireplace
❑Add�non ❑Alteration ❑Utihty Connection �/ _�
[��4l�sc. I �/I�" � �U�C y" / �/ � °C�Llt�t
CODE: ❑I.R.C. ❑I.B.C. � ,
Type of Construction: I II III IV V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby cert�ty that I have himished mformation on th�s apphcatton whuh is to the best of my knowledge tnie and correct I also cert�fy that I am the owner or authorized agent for the
above-mennoned property and that all construction wtll conform to all exuung state and local laws and will proceed in accordance with subm�tted plans I am aware that the bmldmg
ufficial can voke th�s peimrt for�ust caus Furthermore, I hereby agree that the ary official or a designee may enrer upon the properry to perform necded mspecuons
� X �.� 5 - �3 -�o
Signature t 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 Applica omes Your Building Pernut When Approved Paid Recei t NO.
s �� �� Date B
nidin� Utticial Date
Th�s is to erhfy that the requcst m the above apphcahon and accompanymg documents �s m accordance with the Ccty Zoamg Ordmance and may proceed as requcsted This ducument
when signed by the Gty Planner consUtutes a temporary Cert�ficate of Zonmg comphance and allows construchan to commence. Be re occu ncy, a c if cate of c c ust be
,ss�,td �',�t ����1� /�c/Z ZS' ,�i2aN�" �1� �� ���
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
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� T hereby certify that this survey was prepared by me dr �
I I under my direct supervision and tha I am a duly Registered
�� Land Surveyor under the Laws of the State of Minnesota.
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, � Date ���,v�..�or ,�� /FS'� ...• � ..
; Le o . Bohlen
�! Registered Land Surveyar PIO io795