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7 9 ' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 3 /Z
c' __ _, J AND UTILITY CONNECTION PERMIT
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I. White File
2 Pink City PERMIT NO. e lqy
3 Yellow Applicant __
(Please type or irrint and sign at bottom) ---
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PIN
OWNER
(Name) e el O(fWN (Phone) a • 44t) U -13(1 3
(Address) r30,.tyt. (' ° a 2c t e"
PriglihRER CI •Scrc e
(Company Name) C;! e i-.) 9- (Phone) C1J i • Z (-D I(9 74
(Contact Name) _ 4.JtilrlrA 4..e - , 4,.. Ar'. _ (Phone)
(Address) 9 l"Y7.r'1rt4Inc:, (L , YY'`<irytry ek ,I.,- r'nn c(c ('
TYPE OF WORK ❑ New Construction ❑Deck ['Porch DRe-Roofing DRe-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition (Alteration DUtility Connection �� �� ��� ���
CODE: ❑LR.C. ❑I.B.C, ❑ Misc: 9
Type of Construction: I II 111 IV V A B
Occupancy Group: A B E F II I M R S U PROJECT COST /VALUE $ MOO ,0 0
Division: 1 2 3 4 5 (excluding land)
ry en that 1 have furnished 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
nve•rnentii led property and that all construction will main ,,, alt existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
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ocial can to oke this permit for just c u Furthe • tne, 1 li ngrce that the city official or a designee may enter upon the property to perform needed inspections.
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Signature Contractor's License No Date
Permit Valuation Park Support Fee # $ J
e e
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 $
/
This Application Becomes Your Building Permit When Approved Paid 5 ! _ _ . .v O Rec . I t No, a / ®
Date 2 •
rK'�
Building Official Date IP
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 Ditectoi Dale Special Conditions - ir any ._...
24 hour notice for all inspections (952) 447 9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake. Minnesota 55372
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