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M' ` CITY OF PRIOR LAKE BUILDING PERMIT, Date Kec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �,
v
AND UTILITY CONNECTION PERMIT //' //
1. Pink "e PERMIT NO. / / , / Z / l //�//�
3 . Feat City /
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ - Z(' S W/ - 2-f p /e4A/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER AA
(Name) ('r a.'9 ./`t d . rh, ,,,, (Phone) (95 z) W7 - /$‘o
(Address) /5 6 S" /it/' /o%r eq,, w , 7 , Al A/ iA/ P',- /�. /re inn/ 5 ?72.
BUILDER /
(Company Name) r,,,_,,,,-56,) c , (Phone)
(Contact Name) pa, K it /s J er (Phone) (95 2) So ° / s3
(Address) S &7 („/, i39 Sf .Sc t/a AM/ s .373
TYPE OF WORK ❑ New Construction ❑Deck ['Porch e- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F III MR S U PROJECT COST /VALUE $ /' o ®°
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished 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 property 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 revoke permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X c <...,-// / c ,2O 6 38 S f il) .- -//
true Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 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 $
This Application Becomes Your Building Permit When Approved Paid 7. 7c Rec t No. (o Wok 7
Date //. y 0 B
Building Official Date
This is to certify that the request in the above application and a vwpanying 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
4646 Dakota Street S.E., Prior Lake, Minnesota 55372