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i i PRIp CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. en AND UTILITY CONNECTION PERMIT
en bjNNE I White File PERMIT NO
City "7
3 pink C
3 Yellow Applicant
icant
(Please type or print and sign at bottom)
ADDRESS -gyp ZONING (office use
(S t lit Dk
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER C� /+ �j _ _
(Name) utv� S '3,) \ (Phone) l --1
(Address) \ cGt g l/" kr tQ W 'f......_ ) I .
BUII DER „..... l , A _
(Company Name) , ' ∎ Ts r ... ■ LI d _ (Phone) `1 /,> \ v "� `� 7 � 'b
(Contact e) _ZI_` ` 1 16 U IA (Phone) & � .36 - 3C�0
(Address) ) � � Picds I ri '� -- 7t),,
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Roofing (KRe- Siding ❑Lower Level Finish ❑ Fireplace
❑ Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ /c>/ OW'
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby erti that I h e furnished information on this application which is to the best of my knowledge true and cotTect. 1 also certify that 1 am the owner or authorized agent for the
above- , enti. ed 'ro. rty 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 a evoke / p rmit for Just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 11.■i/ C cJ 1 - 13 - . ) � - /,)
Signature Contractor's License No. Date
Permit Valuation �ei.. Park Support Fee # $
Permit Fee $ l - 71 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 App1i . 4 i : e ! mes Your Building Permit Wh App . ved Paid `
at Recei Ili No. d
• Date air c _ z__ By
C W z
. *ate
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. 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