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of "4/44 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE y /3 / 3
oe
AND UTILITY CONNECTION PERMIT
4 r ofivESOl h
I. White File
Pint: City 1 PERMIT NO. /3 • U (� 6Y� ''' -
A P leace y o print and sign at bottom) Yellow Applicant
DDRESS /�
v ['/ e dzI ZONING (office use)
1 9 'F
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER c
ame'}�
A t1 , ` ' - V' I (Phone)
(Address) Y 6 U� 0 ,r5o,„ 5 2 5ft
BUIL FR ,_�
o / �?,, 01- m.an Nam 5 �l `�' Y "" • hon 7 We'
ontact Na . - ■ 6-(.._ 'Ali Y
(Phone)
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TYPE OF WORK 0 New Construction ❑Deck OPorch -Roofing
❑Addition DAlteration �j ❑Re Siding ❑Lower Level Finish 0 Fireplace
❑ Utility Co ctt
CODE: DI.R.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V AB
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
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 1 am the owner or authorized agent for the
above•me•troned 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 budding
official c, revok this •ermit for)us cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed nspections.
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��_ , _ 13
o ntractor's Licens• . o. �_
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 I $ TOTAL DUE $
J �f
This Application Becomes Your Building Permit When Approved Paid 77- L S 4 � �
Rec t No. `
Date e . / 0. By
Building Official Date J
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 -1245
4646 Dakota Street Prior Lake, MN 55372