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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
4", /\.c';; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
cm, AND UTILITY CONNECTION PERMIT 5- /6 . /3
4 74, (-6l"' ,
1. wrote File
z. Fmk cry PERMIT NO.
3. 3. Yellow Applicant 'i
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
36 5 po7:4fTg F4-$5 A/ w
LEGAL DESCRIPTION (office use only) /
LOT BLOCK ADDITION PID
OWNER t- /�— / / U
(Name) le TR L.. Tty.W/ (Phone) lilt' VD CS 7
(Address) 3 ` 5 - 7 Pb.�,vr&- P495 A/ p/
BUILDER GO "�g(' _ V. '!
(Company Name) ' �
2 O Sr___G�T "aN XiM hone
(Contact Name)) &R,. / ''L.44LT1.- g-- ,tl w,� (Phone)
(Address) 1 /4/0 5 l "Yl VlT �4r�}� l !It/ W `r`4' LT At ,N
TYPE OF WORK ❑ ew Construction O eck ['Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
dditi DAlteration ❑Utility Connection
CODE: QI.R.C. I.B.C. ❑ Misc:
Type of Construction. I 11 III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ 7 4 0e ,
Division: 1 2 3 4 5 (esclnding 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 that I am the owner or authorized agent for the
above - mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance bmitted plans. I am aware that the building
official can his permit for • ca use. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X $L 6 3 X47 c --/ e4.a1/ 3
Signature Contractor's License No. Date
Permit Valuation ?r�c�lJ_ Park Support Fee # $
Permit Fee $ t 4-r ,. SAC # $
Plan Check Fee $ W -" j ( 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
C1,J . 22 3 $ z 4G,.
This Application Be ' , , es Your Building Permit oved Paid . .E! • ece ..�►C,eriv i
Date 6 4, 3 B IOW; r sr 3
B uu ding Official Date
/
This is to certify that the request in the above application and accompanying . . , , ents " in accordance with the City Zoning Ordnance and may proceed as requested. This document
when signed by the " Planner constitutes a temporary Certificate of Zonin:- ..mp , ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
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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, Minnesota 55372
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