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P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE c
AND UTILITY CONNECTION PERMIT /30
4 . , L White File
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2. Pink City PERMIT NO. � .. /1!' -
3 Yellow Applicant !Js
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
15 C / Z. R i . *Aa\A NleAAAAL_
LEGAL DESCRIPTION (office use only) 1 j
LOT BLOCK 1 ADDITION S Q.-VYY‘ d 1 (Ju, W A NA( j- APID
OWNER _ t ! S Z / "561
(Name) �� T�, r� , � ( Pho ne)
(Address) 5/ 5: 3 I i Q' & I")-ei-j 1 Pribif LeAk e M A, 5
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction Deck OPorch ❑Re- Roofing ORe-Siding ❑Lower Level Finish ❑ Fireplace
['Addition ['Alter to ❑Utility Connection / 4
CODE: .R.C. ❑LB.C. ❑ Mi D, � sc. h'- P /
G ` x F p : /<
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby ce , at I have furnished in' rmation 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 -men one propertyj+nd ty t all onstrilction 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 ev • e this peril it ; Just ,, use. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform n ed insp Lions.
X ' 0 ' 0_
nature Contractor's License No. Date
Permit Valuation 2_ CND() _ Park Support Fee # $
Permit Fee $ 1 5 IC SAC # $
Plan Check Fee $ ,{ 7 co 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 eted41 33() , 07' $ t Z. Z • 4,1
This p patiki Beco es Your Building Permit en Ap oved Paid /ZL, elpt No. 5770f'
.-- i!,' Date 4-, 7 .
Building Official Date
This is to certify that the r uest in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signe t e Ci i anner constitutes a temporary Certificate of Zoning complia e 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
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