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o p PRi ct.., CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 7 (a 13
AND UTILITY CONNECTION PERMIT
444/NESall' I Wk City / A
Pink PERMIT NO. c�f.,(
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZO G (office use)
/ L(73() c F r r c , q e L AI .•k, rJ ,. (
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) lCe � C 1; r.) C.. (Phone) 9 Sv .t 6 - 63,9
(Address) / 1413 6 C e Y l c 9 �, L q r't e. Ni e
I BUILDER
(Company Name) 4 ll sk s 41' (- 4 C ti ' (Phone) T51,- 7 36 -' 33 A 3
(Contact Name) ( 1 t t Tr i o, (Phone)
(Address) j 7-2,7"3 r CAI (M Ave. , 5 , (�v i,, u v X1(4_, /4") S T 3 3 7
TYPE OF WORK ❑ New Construction . 9.Deck (Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ['Utility Connection
CODE: 6.R.C. D.B.C. ❑ Misc.
Type of Construction: I II III IV V AB
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ d d :.>
(excluding land)
Division: 1 2 3 4 5 i
1 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 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 can rev" this hermit for just cans or I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X / 73r 737 of 5__ �/1 d/i3
Si Contractor's License No. Date
Permit Valuation 70 Q el Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 45 1 k Water Meter Size 5/8 "; I"; $
State Surcharge $ L ; .,")o Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
I
Gas Fireplace Permit Fee $ TOTAL DUE /i -'� 7 / 1 s I $ �Q ("�
'
This AppF ' : • i mes our Building Permit When A ■ .rov: Paid Z-1 ! R eipt No. (O �
Af � � Date "7�C .i �� Y
Buildi _ Official Da'
i
This is to ce„ ify that he request in the above application and accompanying documents in ace dance with the City Zoning Ordinance and may proceed as requested. This document
when sign ,, : th &Illy Planner ct gtttutes a temporary Certificate of Zoning complia c and a ows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued I
C —I . (Z (
' ••'rector ate Special Conditions, if any
• of notice for all inspections (952) 447 - 9850, fax (952) 447 - 4245
4646 Dakota Street Prior Lake, MN 55372
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