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Microsoft • :. a - CITY OF PRIOR LAKE BUILDING PERMIT.doc... http:// www. cityofpriorlake .com /pdf /bldg_permit.pdf
04 ;- 1 -, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
\ ` q TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
r,1 /��__��� „I� AND UTILITY CONNECTION PERMIT
4 io , ,sQ /711 75 1. 4 3 White
Fink Cit PERMIT NO . 13 „ /l y
2. Pink City /
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (orrice use)
(y R 1 OPOLLA t■' D e itC.`l. i e.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ,, (Phone) ...__ 9 ~7 ? 7 V 1-5
I
(Address) VY■ v6g
BUILDER l.AK clam , (Phone) 95A 006 - 5 5SO
(Company Name) 9 Phone
(Contact Name)—?)\11 (Phone) 952 5 - t gl ki
(Address)
TYPE OF WORK ❑ New Constnmtion :Bieck ❑Porch Cite - Roofing Re Siding DLower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ELR.C. ❑I.B.C. ❑ Misa
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ I t
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I 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
above - mentioned properly and that all 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 can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Pate
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 5 TOTAL DUE $
This Application Becomes Your Building Permit What Approved Pais .regfi"►aL1111111 R.eceiet No. / t�t�
Date iggial B i
. ,/ I
Budding Official Date
This is to
certify thar 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 tetnporary 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 S.E., Prior Lake, bliunesosa 55372
l ofl 3/11/2013 2:20 PM