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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT .7 Z 4 , 1 -3
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Pink Co. PERMIT NO. / 3
,. Yen°. Applicant
(Please type or print and sip at bottom)
ADDRESS
ZONING (office use)
57 0 ? PO AI OS
LEGAL DESCRIPTION (office use onto
LOT BLOCK ADDITION
PID
OWNER
(Name) Eli 6 C. Fegh-e.,L
(Phone) ,4"? -e- - 5 . ) -7 pfal
(Address)
BlUILDER
(Company Name) p EILF ExTE-e___ (-40 r___. (Phone) 7e-3 -- -- -e?'06
(Contact Name) :Teri- Co g - EWA! t.A.i 10 (Phone) 71.3 — .P - 6 Q't 6 14
(Address) 51 (4, P i )`) 6 c Or: ON-4;•■■I en C-6.1.-Z + _.11_isi_____
TYPE OF WORK 0 New Construction 0Deek 0Porch ,e-Roofing 0Re-Siding 0Lower Level Finish 0 Fireplace
0Addition 0Alteration OUtility Connection
CODE: CII.R.C. IDI.B.C. 0 misc:
Type of Construction: 1 II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST/VALUE $ /4„. 50
Division: I 2 3 4 5 (excluding land)
1 hereby certify that I have furnished information on this application which is to he best of my knowledge true and eorrect. I also certify that I am the owner or authorized agent for the
above property 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 .a vo t.is $ rmi or just cause . r rthermo hereby agree that r
e, I hereb the city official or a designee may entei upon the property to perform needed inspections.
s./ _,,,, / c
, An / 0 - / 3 5 inspections.
/ I 11" .
Signature Contractor's License No. te
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 $ TOTAL DUE $
— .
This Application Becomes Your Building Permit When Approved Paid jkdWIIIIIIIIIILrt et No. ° to _
Date g
Building Official Date
0
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 SpecTal Conditions. if any
24 hour notice for an inspections (952) 447 -9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372