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�PR/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
/ !: TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
/ x AND UTILITY CONNECTION PERMIT s-//-2-/e g,
M„ A'NESC I. white File �Q/�
PERMIT NO
2. Pink City / I� i Q 2, S /
3 Yellow Applicant �/v
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/
C ,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER f }(� ` ) �Q /_
(Name) 4 ' _ _ ` _
Lb . � � � (Phone) 61 - 5O( -7
(Address) [L7(0L C L `1 1 J , G_ - ,,
BUILDER O
nn ,, FAO (Company Name)tj4LLl114EK l i Cif IY pLS. NL (Phone)g Rq , Z (D3ce
(Contact Name) // () ( F � ( �_- j (Phone) (014,-M(.9- n - I S l iS
(Address) ILQ4- �.�llb(pp�1��( C 1 1\1\t‘ \. .U� 1 h e i , C I k
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch J Roofing Re- Siding ['Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ['Utility Conne do
CODE:.I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E 6 H I MR S U PROJECT COST /VALUE $
1 Division: 1 2 3 4 5
(excluding land)
I hereby certify that I have hirnished information on this application Which is to the best of my knowledge true and correct. I also certify that 1 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 this permit for just cau Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X Cr CJ 11-yet —'2.--O"R
•
ign re Contractor's License No. — ,. —
Permit Valuation O Crb Park Support Fee # $
Permit Fee $ '7% 7 S SAC # $
7�
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 1 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(0 Q 0
This Application Becomes Your Building Permit When Approved Paid P 74.0 O Receipt No. 5 S7 3 4
S i 2A4 - 1 - 12 ' / ` )r 5 cP Date 5 7 1 2 4 0 8 - By
Buildin Official Dat
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. T ent
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Oc pancy must e
issued
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245 7
4646 Dakota Street Prior Lake, MN 55372 /