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04 -p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ! 9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"" j \ AND UTILITY CONNECTION PERMIT
I. white Ci: PERMIT NO. // bi5:s
2. fink City
3. Yellow .Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
. 2g6 3 5pr' i A to ,, d
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER / /
(Name) &Ma& AU/4W S _ (Phone)
(Address) ,X1:16; f ...Tot"-, si � 4I ,Z/ jar 4 k, "3,f/r/ S'":
BUILDER > // �/
(Company Name) - -'t ,1u tw 4L- / S �G (Phone) 76 f - -jS 7 VS�
(Contact Name) _ _ ' , O�CC (Phone) 2' 19$ ' ' s $
(Address) / s , „ . / l /t' / 4,e / �1 /V A' S
TYPE OF WORK ❑ New Construction ['Deck ❑Porch /° - Roofing ❑Re Siding ❑ . liver Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V AB as
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ /ewe
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 pro. - -- . d 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 rev. - . , it for ju :,: Fu • rm. - I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X , / / / _ ,e' 30/ T/�j _ _ !/ /: /�oe
400 .--„.. - Contractor's License No. da te
Permit Valuation Park Support Fe' # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1"; $
State Surcharge I $ Pressure Reducer $
Penalty $ Sewer /Water C< :iuec:i,,n i^ ca # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ G
8
This Application Becomes Your Building Permit When Approved Paid i ' ` Recei. ' 1 o. /Q
Date 8 — - - 1 By
Building Official Date v /
This is to certify that the request in the above application and accompanying documents is in accordance with the Ciry Zor.in . 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, fm (952) 447 -4245
4646 Dakota Street S.E., Pr'or Lal: ?, ".vnnesota 55372