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-141/0. CITY OF PRIOR LAKE BUILDING PERMIT,
Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x AND UTILITY CONNECTION PERMIT
U r .,,
y '. 1 while File
? Pink City I PERMIT NO. /3 < zi L 7 ‘
HNEB ��
Yellow Applicant
(Please type or print and sign at bottom) ZONING (office use)
ADDRESS
)5 - 1S 3/ 8 J eger P*J S
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER .. o n (Phone) 61 2' 2 2/ ti 5.2
(Name) Q e�al C. tot r 4SSo e;
(Address) 'Jt.3fil'r - r ftt 296 j‘,d,' / /td. Qvr,„v.ffe /TAI SS3 37
BUILDER (Phone) 761 2 2 - 61 Pi‘
(Company Name), All Et t^t^ fi s Tel "
(Contact Name) J v st G 33`71‘ L. (Phone) ?4 3 " 202 � �+ ^
(Address) )3i7 O 3 C er `
1 c /1 7, , D . /741 53 3 2
TYPE OF WORK 0 New Construction DDeck DPorch e- Roofing DRe- Siding ❑Lower Level Finish 0 Fireplace
DAddition DAlteration DUtility Connfction
❑ Misc.
CODE: DI.R.C. DI.B.C. 2 2 2 7
Type of Construction: I II III IV V A B PROTECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
a mentioned and that all con auction this ill onform all existing state and local laws and will proceed in accordance with t submitted d plan owner I a aware i that the bidding
abo P to perform needed inspections.
official can rev ke this permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property P �' ^1 3
X Contractor's License No. Date
/ Signature
Park Support Fee # $
Permit Valuation
Permit Fee $ SAC # $
$
Plan Check Fee $ Water Meter Size 5/8 "; I ";
Pressure Reducer $
State Surcharge $
Sewer /Water Connection Fee # $
Penalty $
$ Water Tower Fee # $
Plumbing Permit Fee Builder's Deposit $
Mechanical Permit Fee $ $
Sewer & Water Permit Fee $ Other 5
Gas Fireplace Permit Fee I $ $
TOTAL DUE y9 / 73 . Receipt N 9 d �J
This Application Becomes Your Building Permit When Approved
Date , :pi �� 3 Re
Building Official Date
Tis w h e is to ed b y that the Planner a temporary y Certific. to accompanying f Zoning compliance
and construction to commence. Ordinance
Before and
cccupancy, a Ce�tlticatti� reqested. This
ofOcct Occupancy must be
when signed by the City
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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