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oF PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT 1 G��,�'� �
�
��NNES��� I. Whiie File
2. I�ink �,t PERMIT NO.� 1 _��� / y
3 Ye@ow Applitam d
Please or rint and si at bottom)
ADDRESS ZONING (ottice use>
51 �7 �� ��GS �� f S�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /� , / q c
(Name) � 0'�' S L4�w� (Phone) � l�' l7 b��� w
(Address) � �j 107 �� ��� f✓�-� � ��
BIJII,DER ��,�� /
(Company Name) D �%� � `{ ����'� �� (Phone)
(Contact Name) �� � (Phone) �l�a2
(Address) � 7� �(M�S W �'�,r,�,
TYP'E OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roo6ng ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑T.B.C. p Misc.
Type of Construction: I II III N V A B �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALLTE S 1 �7,
Division: I 2 3 4 5
(excluding land)
I hereby certiCy that [ have fumished mforma[ion on this application which is ro the brst of my know►edge tn�e and correct. I also certify that 1 am the owncr or authonud agent for the
above-mentioned propc�ty and that atI construction will conform ro all exuting stace and tocal laws and will proceed in aceordance with submitted plans. I am awaze that the buildmg
utl'icial can revoke this permit for just use Furthermore, I hereby agree thak the ciry officia! or a designee may enter upon the property to pc��form necded mspcctions.
}( � � !✓L �Zq7 y� L � � (� L r / �
Signature Contractor's License No. Date
Permit Valuation �- G Park Support Fee # $
Permit Fee $ 7 � . S .- 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 AQpticatiort Becomes Yoar Building Permit When Approved pa�d G Recei t No. U
Date G �- �- �- -! Y B
�� -��-i.Y
Buildin�� (�tlicial Dnte
This �s to certify that thr requcst in [he above apPiicaunn and accumpanying documents u in accordance with the Ciry Zoning Ordinanm and may protted a. rcqucsred. Th�s dexumcnt
when signed by the City Planner cunstrtutes a tempaary Certificate of Zoning compliance and altuws canstruction to eommence. Befure �xcupancy, a Cernticate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for ali inspections (952) 447-985(1, fax (952) 447-4245
4646 Dakota Street Prior Lake MN 55372