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i PR: CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPO CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
INNE SO.. I. white File PERMIT NO.
2. Pink City
fir-
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
`--./ D 7 c%p 2 rj f ru o o r, -- t - 1 7 - A., c
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER � - d/U L) L.) S S �S / - � C'gq�5
(Name) (Phone)
(Address)
BUILDER L L C (- - - 1 ci 6 - 'q C c31
(Company Name) r 0 L'`- A 0Q (Phone)
(Contact Name) D v41 fN rt tC t /' (Phone)
(Address) f 6 1' W to ; 14 R V n_ V, l ,2 j v rk_Gv S V LA.... .- 5 3 3' 2
I
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: Yillat.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ s p 0
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
f 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 constr ill conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
offic an revoke this permit for just cause ore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
lam. of & 3 t tRe, g
Signature Contractor's License No. v Date
Permit Valuation -Z-- Park Support Fee # $
..
Permit Fee $ '7 7 t r" SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ ' ( 1--C— 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 Firep e Permit Fee �, $ TOTAL DUE $ -- / .�
/ goo
This , 1.f , ■ i Y. co . • ' our Buil • m t' Appr. ed Paid 7 6 Receipt No. 5-2j � Date �1 By
Buildit Official 2 Date
This is to certify that t • . i . • .. - 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
4646 Dakota Street Prior Lake, MN 55372