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o* PR/p� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A . TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x AND UTILITY CONNECTION PERMIT
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4 /NNE SOtt. I White File PERMIT NO .
2 Pink City �f {, V 7� y - =S
3 Yellow Applicant `
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
-iq 1 Odd go'? s 1....")
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER . —•
(Name) J !3 GCLt C LC- Di--/ e (Phone) f.;l� eie - 9q 0
(Address) 3 2 g -/ 5,10/ c /c.-1, 5 `t/
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ['Utility Connection r A
CODE: AI..C. ❑ E
I.B.C. k Misc. `E S ` t IN J-�
Type of Qo3�st I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
'\' hereby certify that 1 have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner or authorized agent for the
above - mentioned propel and that all co ruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official ca r v e this emit fo r t c Furthermore, 1 hereby agree that the city official or a designee may enter upon the property to perform needed i peal s.
X/ ' 1 1 '
.ignature Contractor's License No. Date
Permit Valuation
-2-5-040 , Park Support Fee # $
Permit Fee $ 7 A �i -- 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 $ 1 ! " 75'
•
This cation " ', Building Permit en A roved Paid 77, Receipt_NQ. �j 4- cis ZI
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'� j � 1 Date 4 0 't-- By � ((��„_"
Builditr_ Utii f gate
This is to c • ify that t. • requ st in t above application and accompanying doct ents . in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sig the f Pp er 5 mutes a temporary Certificate of Zoning c plia c and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued I t • °,,, rr
'tanning Direct. ate Special Conditions, if any
our notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
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APPROVED -
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WHO' . .
IAA !,), i'IUOR WOOD OuolA Gount41 MinnuouLo. Alou ohuwing:. We luuabluu or t,ho
propouud houoo au utaked his 13th day or July, 1994. . •
r's"*.4%.1 NOTW
fieloohmirk Elmvotion 937.59 top na, a Lho hydvonL ta I..,ho NW oov. Lot; 3.