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141:(14/1 � � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�' AND UTILITY CONNECTION PERMIT
&ESO
1. white File P NO.
3 . e City // - //
3. Yellow w Applicant
(Please type or print and sign at bottom)
ADDRESS f L k t ) R al
l5f�e(�'�C�,�c:J� . r RIO, � ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) (_
'.1V 1d A�_k''l ,� l C'� } (Phone) I ‘...)(9 " `I q t i - f 3
` ii `` hone )
(Address) 1 J tit ID W 006 -duck .Tr. \J i Pf (, ( Lc' & i I^' .'�0 � 53'7 a
BUILDER
(Company Name) 1 1' r - JU L (Phone) - � � ' - 5 o 2 9 1
(Contact Name) - tAr> (Phone) 952- - '1 G& C 7 — CI oZ crZ
(Address) )( ())(1 1 L Ac's el \i t iu., ow 656E4 q
TYPE OF WORK ❑ New on Construction ODeck OPorch Re- Roofing ORe- Siding OLower Level Finish 0 Fireplace
❑A
DAlteration DUtility Conne on
CODE: DI.R.C. DI.B.C. 0 Misc:
Type of Construction: I II III IV V A B 0 H i
Occupancy Group: A B E F 1 M R S U PROJECT COST /VALUE $ (J eroo y
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished ' . w ... tion 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 - mention., property and ..r.1 all con ..'on will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official r- .. u -. 'urthermor . 'by agree that the city official or a designee may enter upon the property to perform needed'
I � � � I� inspections.
Vii, �a_if l eC_te3 31 /d -el 9 • o If
Signature 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 $ 79 75
This Application Becomes Your Building Permit When Approved Paid 7
Date / 01 M Recei a ;'� 6
Building Official Date /
This to certify that the request in the above application and accompanying documents is in a000rdance with the City Zoning Ordinance and ma
sign by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupa Y y as ncy, a Certificate o a of O f O d This document
must be b
issued. ccupancy must
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