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PR/ CITY OF PRIOR LAKE BUILDING PERMIT, 7 ! t 7 � Date Rec'd
o ■P
t. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ¢. 4-, `/
AND UTILITY CONNECTION PERMIT .
Lead Cert No:
iA'NESO I. White File
NAT 27064 -1 2 Pink Cppl PERMIT NO. / / Z 0 8
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
4 /654 CO--Ri61 6 4. /9 a//2.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER (Phone )q? 47- 33
(Address)q/Ps'7 Ci& ). Q L %L- ,, f l'l A) C
BUILDER 7 / -t� Pe_414-1)Cle_AA.4 / p ' 1 ' / (Company Name)1. plivw (Phone) 4 �� � � �'�" � � � `�' l�
(Contact Name) �_ � _ 2_,,O---1-et-L) (Phone) 5 A V r
(Address)`) / i ' ,0}► . �litti -� X44,.p. I ' » / N ES D /Li
TYPE OF WORK ❑ New Construction ['Deck EPorch ['Re-Roofing 15 r e -SSidi ['Lower Level Finish 1:1 Fireplace
EAddition EAlteration ❑Utility Connection S 'O � i
CODE: DI.R.C. I.B.C. ❑ dMlsc /3 an
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ 3 T, boo
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have burnished Information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above - mentioned p ii erty 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 revo permit for ius cause Furthe'm e, I hereby agre • • that the city official or a designee en up uppp the property to perform n eeded inspections. I
X e - - ice' I / b l d (/ �— 3 `/- `l
1 Sign re Contractor's License No. Date
Permit Valuation Z SDU_ 00 Park Support Fee # $
Permit Fee $ 7 -77 SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ ` / JD Pressure Reducer $
Penalty $ vv 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 $ 77 76
This Application Becomes Your Building Permit When Approved Paid 7 Re ipt No. 62.176
Date ¢,'i`/ � ,
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with ttf(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