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f PRit; CITY OF PRIOR LAKE BUILDING PERMIT, Date ec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 4/27/3
. op t.
tn AND UTILITY CONNECTION PERMIT
4'NNesotr I venire File PERMIT NO . 3 6,9�
2
Pint: City ! J
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
SS 7 Z
cPD 7» N. E R z S,A
LEGAL DESCRIPTION (office use only) �-
LOT LOCK / ADDITION (.a) kit) ie. n � 3 /��' 4 b6 J PID 6?5— l ' -&a� —0
OWNER 12
(Name) "% L �i-aQ S V■ (Phone)
(Address)
BUILDER ,
(Company Name) �/ �i ' S e)C , an t- (Phone) 73 `-°� S - 0 v 6 3
(Contact Name) 4-reo •J Z 4.^1 i'z (Phone) es::.( 2 CY`r- 0 2-? G
(Address) I LS O v t" f, C-- IS 1 6 ro✓ ,_ u�(�S ,$S? 6 I
TYPE OF WORK ❑ New Construction ['Deck ❑Porch c -- e- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ['Utility Conn $�
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. =-� `� z `�• �`�
Type of Construction: I II III IV V AB _ �_ _
PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have i • ed infor ation on this application which is to st of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above - mentioned pro. and that all nstruction will conform to all ex to and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revo'- is permit form • ause Furthermore, I hereb at the city official or a designee may on
ayy enter upon the property to perform needed Inspections.
X Ec 3o T 1I 3 -(
IIIIIIII■ Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 74 • ? ,✓ SAC # $
Plan Check Fee $ / Water Meter Size 5/8 "; I "; $
State Surcharge $ CI oc) 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 1 $ TOTAL DUE $ '71 . #7
This Application Becomes Your Building Permit en Appr ved Ids � `� Receipt No. , "(
k - - Ai. G ' Da te 2... 2... c ' By l�=
Bi u " ntg Orli it Date
This is to certify that the req - 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