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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT / I / I / b 7
File
City
Applicant
PERMIT NO. 0'7-/ OS'1
I White
Pink
Yellow
Please n at bottom)
ADDRESS
"3 '-t aD ~ovvf- C \fVCLe--
V\..w"
~{~-L- M,Ar
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNE~
(Name) nh y
/
(Address)
5:f-ifiLVV-
4,.,t.t...4
(Phone) 'f62- Co.{ I..{o J't I Lf
ZONING (office use)
~
i BUILDER ~ t _
I (Company Name) ~ '-e--y
I /'
I (Contact Name)
I (Address)
(Phone) 7 h") 7 i' (j b J..l t)
(Phone)
TYPE OF WORK 0 New Construction ODeck o Porch ~e-Roofing ORe-Siding OLower Level FinIsh 0 Fireplace
OAddltlOn OAlteration OUtility Conneefuln
CODE: IX1LR.C. OLB.C.
Type of C~;'stmction:
Occupancy Group: A B
Division:
o Mise
$ Ji, IJlJtJ
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
B
S
U
PROJECT COST IV ALUE
(excluding land)
I hereby certily that I have hlrmshed ml,)rmatlOn on this applicatIOn WhICh IS my 'nowlcdge true and cone J) certify that I am the owner or authonzed agent I'll the
above-mentIOned pruperty and that ,,11 mnstrllctllJn wrll cnnt(,r eXlstrng state "nd Incallaws and will proceed in accordance with submitted plilns I "m aware that the bUlldrng
ercby agree that the CIty official or a deSIgnee may enter upon the propelty to pcrtc)rm needed tnSpcctHlflS
1.-.0?-~~03o ~7
Contractor's License No. Date
Permit Valuation
Park Support Fee
SAC
Permit Fee
Plan Check Fee
Water Meter Size 5/8"; I";
Pressure Reducer
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
."2....-s
$
$
$
I $
$
Sewer/Water ConnectIon Fee
Water Tower Fee
Builder's Deposit
Other
Sewer & Water Permit Fee
Gas Fireplace PermIt Fee
TOTAL DUE
I Paid ~. OD
Date I, 7
I This Application Becomes Your Building Permit When Approved
I~~
I Buildlllg llfllclal
II It /0 I
,
Date
#
$
$
$
$
$
$
$
$
$ 7". 0 0
I Receipt No. 5i!.P9S
.. By 6f,
#
#
#
ThIS IS to certify that the request in the above applicatInI1 and accompanY1l1g documents is In accordance with the City Zoning Ordinance and may proceed as requested ThlS document
when signed by the City Planner constItutes a temporary Certificate of ZOl1l11g complIance and allows constructIon to commence Before occupancy, a Certificate of Occupancy must be
issucd
Planning Director
Date
24 hour notiee for all inspeetions (952) 447-98511. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any