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PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY AND CERTIFICATE
UTILITY OF ZONING CONNE CTION PERMIT b COMPLIANCE C ,
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afi S� �P L White File PERMIT NO . 9
3 Pink City �/. ,04,5- 3 Yellow Applicant
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(Please type or print and sign at bottom)
ADDRESS
1 4-800 , KLA w r , D BEACH ZONING c�c)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION RLs 41 00 PID 2572.0Z_ 001 0
OWNER M I I H - =�`.'� '
(Name) Ti M 3 (Phone) � � Z �(� 7c
(Address) 13736 /lei ix /014 4v-e 5, r i . � 1 ' .37s
BUILDER
(Company Name) (Phone)
(Contact Name) - -
(Address)
∎1� v4i ,: rormivirearkai magmis■
TYPE OF WORK ❑ New Cons, • ction *Deck ❑Porch DRe-Roofing ❑Re- Siding ❑Lower Lev: Finish ❑ eplace
['Addition • ter s i ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. .
Type of Construction: I II III IV V A B 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 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 confor.. . all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official car. rev or lust • r"-rm. , 9' y agree that the city official or a designee may enter upon the property to perform needed inspections.
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Signature Contractor's License No. Date
Permit Valuation I 61.51) (10 Park Support Fee # $
Permit Fee $ 3 4,. ' C SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ ` U Pressure Reducer $
Penalty $ J 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 $ 3 s 25
This Application Becomes Your Building Permit When Approved Paid 3 ' ceipt No. ,,,'
Date ", v' 1 .
Building Official Date
6
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 -4245
4646 Dakota Street Prior Lake, MN 55372