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(C. 28 ()1
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Applicant
PERMIT NO. 07 05
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT )t'JBLOCK
ADDITION
PIDZ,(' . L~-L _ 6() J _ r)
OWNER ~^\IIP \1
(Name)~ [(>>1YOy
(Address) 1'333 nt
TYPE OF WORK 0 New Construction ODeck OPorch
OAddition OAlteration OUtility Conn
CODE: DI.R.C. DI.B.c.
Type of Construction:
Ocrupancy Group: A B
Division:
III
H
2
IV V
I M
3 4
A
R
5
I
E
II
F
I
(Phone)
L-1l-1 O--?o13
(Phone)
(Phone) ~eS--JZ2l
e-Roofing
tlon
ORe-Siding
OLower Level Fimsh
o Fireplace
o Mise.
B
S
'1'100
J
U
PROJECT COST IV ALUE
(excluding land)
$
I hereby certify that I h~ve hlrlllShed lOf()rm~tlOn on this ~pplic~tJOn whIch IS to the hest llf my knowledge true ~nd correct I ~lso certify th~t I ~m the llwner or ~uthllnzl'd ~gent t(n the
<lbl)vl'-mcntlOncd property and that all Clmstrllction will conform to allCxlstmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
~ti:K:\~dclrj~GSerehY ~gree th~t the CIty oflici~l or ~ dToeSC)r upon the prnpeny to perfillm nc;,/2E/fr7 ~___
SIgnature Contractor's License No Date
Permit Valuation
Permit Fee $
Plan Check Fcc $
State Surcharge $
i Penalty $
I Plumbing Permit Fee $
MechanIcal Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace PermIt Fee $ I
This Application Becomes Your Building Permit When Approved
Htnldtng Urticlal
Dafe
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water ConnectIOn Fee # $
Water Tower Fee #
Builder's Deposit
Other
TOTAL DUE
This is to certify that the requcst 1Il the above applicatlOl1 and accompanYl11g documents is lt1 accordance with the City Zoning Ordinance and may proceed as requested ThiS document
when Signed by the City Planner Cllnstltlltes ~ temporary Certltic~te of Zonll1g complrance ~nd ~llows elll1strllctJon to commence Before l)CCllp~ncy, ~ Certificate of Occllp~ncy mllst be
issued
Planning Director
Special Conditions, if any
Date
24 hOllr ootice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372