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PR:i CITY OF PRIOR LAKE BUILDING PERMIT, vi u 1 2 ' l Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ,4 Q
.„, ,,,,,/ k t ....
.. AND UTILITY CONNECTION PERMIT "Je Ay N0
U
\O, 1)-' A',�'NE 'C P I. White File PERMIT NO . /�
3 Yellow Applicant / D p / ! Lam+
3 Pink City
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
Ic 1 E c8 ;h.00rou3k PcLe,. AE.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER -1)..e.., 95 a — y9 '-- t/9
eco
(Name) !�, C �'�.1 `'�� ( Phone)
(Address)
BUILDER Q / te I _ L1 ']
(Company Name) r WC�Q F. X A 11('��YC/�7 (Phone) 161 ' l0 7 r 9 7 T9"
(Contact Na (Phone)
q me) co, ,J
(Address) 19 ao W 1 ld 'tC . • / . j o -e_LA � ('e, IN 55)) 3
TYPE OF WORK ❑ New Construction ❑Deck EPorch ❑Re- Roofing ❑Re- Siding ❑Lo�w Level Finish 1:1 Fireplace
❑Addition ❑Alteration ❑Utility Connection `ac.e. 1 yOUN' 0 d COY u^') i r Sil
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. OpeiY111 ,
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ -3 / 03'4
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the owner or authorized agent for the
above - mentio ed property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official can • • oke this permit fo t cause. Furthermore, I hereby agree that the city official or a desi nee may enter upon the roperty to perform needed inspections.
X / P a •i c 0 I 3 1 -0 -10
Signature Contractor's License No. • Date
PermiSiefiWkendeteCtOrS shall be. 1 p$'radcd Park Support Fee # $ Permitftper the requirements of the SAC # $
IRC
P1a bTh u the house. BAttery operates Water Meter Size 5/8 "; 1 "; $
stateanalwdetectors may A installed in Pressure Reducer $
Penalty existing strut ;sires. 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 $ 1 T. 7 3
This Application Becomes Your Building Permit When Approved Paid 7 9 'C Rec t No. 4, 1 1-6 7
Date /d. 7, i 0 By
Building Official Date
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