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o f ?R CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE . •
x AND UTILITY CONNECTION PERMIT
v
M'NNES0;1/ I. White File PERMIT NO.
3 Pink City /�O
3 Yellow City I Lv/
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
i OA iittm490 aw4ke A(14 -iaiuta i 1 '1 { (5
LEGAL DESCRIPTION (office use only)
LOT /BLOCK ADDITION PID
OWNER Tern j. C � `�"�" r 1i4/) `7 - Z • (Phone)
\:b %
(Address)
( C o DER ,I L % 5O � - '5
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(Company Name) _ � � ! � f �� �� 11 C. (Phone)
(Contact Name) Q k 1. V O' LS Phone)
s 8 ' : I/ .e i, ' 553 .
( , Ad' ess 'i OBL its i i � h 1 Ty o,I. Alt_ •
• ' E • F WORK ❑ ew Construction ❑Deck ❑Porch ❑Re -Roofi • ❑ , - Siding r ower Level Finish ❑ Fireplace
DAddition DAlteration ❑Utility Connection ■ isc. /46-0 o(J
CODE: ❑I.R.C. ❑I.B.C. PROJECT COST /VALUE S
Type of Construction: I II III IV V A B (excluding land)
Occupancy Group: A BE F HI MR S U
Division: 1 2 3 4 5
I hereby certify that I have furnished i ormation 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 property and tha a construction • o i form to a ens ng state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this permit for j cause. Furth - hereb a t city official or a designee may enter upon the property to perform needed to ns. /
X it ( l 3 1 11
S ature Contractors License No.
r Date
Permit Valuation Park Support Fee # $
Permit Fee $ 74 :75 SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 5 . 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 — $ 78.75
This Application Becomes Your Building Permit When Approved Paid 1 —` R ipt No. (q `f (p 1 (s
Date I i- Cf., d / B -
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the 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
16200 Eagle Creek Avenue Prior Lake, MN 55372