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1 0 C , A PR 'p CITY OF PRIOR LAKE BUILDING PERMIT,
�'� Date Recd
,t TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
*eA , 9
AND UTILITY CONNECTION PERMIT
is White File PERMIT NO. / /
(Please type or print and sign at bottom) 3 . Yellow Appliesnt ! to 70
ADDRESS ZONING (office use)
'<5(FlY9 6020- 54 5'_
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER (Name) 0 5 4 tilt. rb I.. � C Cr rt. AL O ( 7 — ) 1 /7 — Xi 3 / (Phone) )
(Address) 557 CI � j '� . f ,/� S--e_ l� rc l a ,/ /R V
BUILDER p q,
(Company Name) �ki� i -� its f�L� (Phone) 15 2 — e 98 ` VV 5 /
(Contact Name) r1 5f. ti; ,,>"` `
- ' {-
(Address) � ,� (Phone) '5Zr� ".'�� " / y Lj
I3c(6r ceuir 4x , l;7 h,60i i 4
TYPE OF WORK ❑ New Construction ❑Deck ['Porch �Re- Roofing ❑Re -Si
['Addition ['Alteration ['Lower Level Finish 0 Fir lace
['Alteration ['Utility Connection �
CODE: DI.R.C. DI.B.C. ❑ Misc:
Type of Construction: I 11 III IV V A B q [�
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ 7 -/ 1 1 53 , f 7
Division: 1 2 3 4 5 (excluding land)
—
I hereby certify that I have furnished ' crmation 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 1
above- mentioned property and tha 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 c evoke this pe 't ust cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspe ions.
Signature Contractor's License No. D
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 $
— 7
This Application Becomes Your Building Permit When Approved /
I P aid � mi l , ZJ I ceipt No. ( 3¢3 7 Date 7 ..2—r, G ( y
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
when signed by the City Planner constitutes a temporary Ce of Zoning compliance and allows construction to commence. Before occupancy, proceed as requested. This document
issued. a Certificate of Occupa must be
Planning Director Date
Special Conditions, deny
24 hour notice for all inspections (952)447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372