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o f PRI% CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 3/.17—
PERMIT NO
U P
��NNESO�� I. White File
2 Pink ` 5/5"
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3L-1-2- , ,trJ - M G'v- EUJ /
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID Zs. 442.0 LL . 0
OWNER
a 42-- (S1-4 rnel (Phone) C t'32 ` t lq.03
(Address) 3 3 ( 47, -A C/1 SW
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction eck ❑Porch ❑Re- Roofing Re -Siding g ❑ g ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: I.R.C. ❑I.B.C. ❑ Misc.
Type of onstruction: I II HI IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I
I hereby certify that I h, furnished i ormation 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 prop rty and that a 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 thi permit for ius cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation 4/ a e 0 • d O Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 6 6 IS Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Z — 0 0 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 n Yh t ED �, I y,5--
$ / 71.
This A i t n • : ecomes your Building Permit en pproved Paid / / (.. i R ipt No. t > ,f
l04 t'%
x Date 6. 1
i .,....ii 5 ? /ry
Buil _ Date
This is to cer ., tha t•c request in the above application and accompanying docume is in cordance with the City Zoning Ordinance and may proceed as requested. This document
when sig- ,.t th 1 y Planner constit tes a temporary Certificate of Zoning comf ance d allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued / 7.----- ® 5 :t
'fanning Dir. tor i<te Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372