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0 , PR °R CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
r i• TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U a i '' In AND UTILITY CONNECTION PERMIT
4 "A• N E SOl!
I. White File PERMIT NO. V . " - • 0 D
2. Pink City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
171 S J-- 1Nl lV.e f iv t .4- ,-,ail S E P r )4 puj '7 5 372_
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 5/3 - 3 / 3 rr/� f ' (Phone) /Z
(Name) tJ � fV � U� J r; i Q O � Phone - 6'
(Address) /7/ g)- vv, Idpry.e `/y-fl_ i 9 Prior l-A ke i i / '.i 5 ")72,.
BUILDER
(Name) (Phone)
(Contact Name) (Phone)
(Address) •
TYPE OF WORK ❑ New Construction alDeck - ❑Porch ❑Re- Roofing ❑Re- Siding
❑Lowee Level Finish III Fireplace ❑Addition Alterat DUtility Connection
❑ ` ?�� - / 4 R,/l,e� Cc,4€ 1241 1 L PROJE . •ST /VALUE (excluding land) $ 5 St- D tL t `im l -fic
I he • by certi . • • . have furnished information o i .' • - • .. • w ich is to the best of my knowledge true and correct. I also certify that I am the owner or
autho . . • ent for the ...T.Frasist. one. property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter u n propertyyrform n ded inspections. 'J
?//
o
ignature Contractor's License No. D
Permit Valuation 5 00, Park Support Fee # $ •
Permit Fee $ '). S SAC # $
Plan Check Fee $ t. , Z S Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Q t S° Pressure Reducer $
Penalty $ City SAC and WAC # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fire, ace Permit Fee $ TOTAL DUE $ 4 t . 15
•
ThisJ�'plica.. � t di me r! - gin .'t Wh- Appro + ��
■ , ed Paid 4 • — Recei.t No. 1
) III Date �if� B �►�rf.W�
Bu i din! • - cial �T 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
16200 Eagle Creek Avenue Prior Lake, MN 55372