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cs P R /9 .0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
17;. 75'
! TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
3 AND UTILITY CONNECTION PERMIT
`N'NES�
I. white File
2. Pink City PERMIT NO. jZ _ `6 19
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
315( BU-4-teril)(k-f Cirde N Vki
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID •
OWNER c_ .p 1 I ar K l V Si i Uer ll (Phone) 6 5a ' 1 4 L V7 ' (05S0
(Address) 31 5a bii,4-1-erhu+
C.,i1>
NW V P 1 Lab , t 1' ' 1 `, f 3
BUILDER L i U U V1 ✓ U '(. cam ( ) ` I S • �Q U t .'l b � 7
(Company Name) 5 Phone
�'I 1 (Phone)
I t � t • (Contact Name) a J i t.
(Address) 1 c ( 03 I dw (h �� 002
Y
TYPE OF WORK ['New Cons uctio ['Deck ❑Porch Re- Roofing ❑Re- Siding ['Lower Level Finish [I Fireplace
['Addition teration ['Utility Connecti
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B O D 0 c
Occupancy Group: A B E F A I M R S U PROJECT COST /VALUE $ [ V D •
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have famished information 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,. • . . oned property a . • -: all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. am aware that the building
off al can r voke this pe • It for jus � cause. Furthermore, I hereby agree that the city officia dp�gn m y�nt up the ppperry to perform needed in • • ections.
L J L ■_� /. �.� Date
f Signature Contractor's License No. _
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 W,�► Recei , t o I, WI1-
Date '//M B 4111
Building Official Date
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 S.E., Prior Lake, Minnesota 55372