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e ft F PR /p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT �� - (3
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4•A,NESOlr I White Fite PERMIT NO }^
3 pelts City / 3 ,' �G /
YeApplicant ���!!! 7
(Please type or print and sign at bottom)
ADDRESS . (office use)
, q/ 1Z4b? s,- i R l
LEGAL DESCRIPTION (office use only) Lt
LOT BLOCK — ADDITION ( /tO 2 -� /ee / s 7 446/V PID ( ?5" - O Q C�7.� n
OWNER /'�
(Name) K a c / ' . '4Y2 (Phone)
(Address) e / Al r7, _re
BUILDER
(Company Name) *1e .-e3 ✓'Z. /' n ; - (Phone)
lip
(Contact Name) 7 . "----/- (Phone) 7i
z--9(77- y725c9
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch e- Roofing ❑Re- Siding ❑Lower Level Finish E] Fireplace
❑Addition ❑Alteration ❑Utility Conne io
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. ____
Type of Construction: I II III IV V A B �
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
(excluding land)
Division: 1 2 3 4 5
I hereby certify that I have hunished 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 - mentioned property and that . . snuction 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 revo . rmit for - use Furthermore y agree that the city official or a estgnee may enter upon the property to perform needed inspections -
X C',. '/ / 2 `'' //.
' Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water r Meter Size 5/8 "; 1 "; $
State Surcharge $ S Oa Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit S
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ a
r 7
This Application Becomes Your Building Permit When Approved TAW \ L'( ` O Receipt No. 7,00 S li
S c Date 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