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F PR/ CITY OF PRIOR LAKE BUILDING PERMIT, (' Date Recd
/ 6 -(
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x AND UTILITY CONNECTION PERMIT
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��NNE50 I. White File
Pint: city PERMIT NO. )), _ 1) I I1
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS / ;� 7---. ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER / / 2 L
(Name) ��°c- a /a_n lel" ( Phone) 55 79 , 2J
(Address) — /9, //e.. e-- / /►` /de? d-- 7 0
BUILDER / ,
(Company Name) my /? /7Gt. 0C. . �e /'/ LG_j (Phone) 21i? 91/ ORlf
(Contact Name) ..✓C (Phone)
(Address) //t K 4 / �� / -5f
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch , e-Roofing ❑Re- 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 $ /7J J
Occupancy Group: A B E F HI MR S U (excluding land) /
Division: 1 2 3 4 5
1 hereby certify that I have furnished information on this application w• ch 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 property and that 1 consructi will conform to. 1 existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this r • (t-for t caus Fu m. .e, 1 • feb gree that the city official or a des e may enter upon the property to perform needed inspections. _
‘ J /5
: i : r - Contractor's License No. 'Date
Permit Valuation IS U -6 Park Support Fee # $
Permit Fee $ 7Cf. 75 ._ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1"; $
State Surcharge $ C-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 I $ TOTAL DUE $ '7?.----7
This Application Becomes Your Building Permit When Approved Paid CIS Li Receipt No. 6' /36
Date / 6 -((o -l- By e we..L-
10--76-/)---
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 Prior Lake, MN 55372