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o f PR1O CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
4.,,'NESOS* t. White File
pivz_ e " . (- G 2. Pink city PERMIT NO. /3 e3 e3 s
3 Yellow Applicant ,
- Please . • or . rint and sign at bottom)
ADDRESS ZONING (office use)
t 5 O - 151(1,. U( -e. oz_a_ L) R) 5,1)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) � 2_ . A,-vv- 4 C •^-l- (Phone) 529 `Z -- 7 /95
(Address) ( - Z C,`7 TS[.-,,-,... U1\ cJ
BUILDER
(Company Name) 0 --LtSri -"00 t4 C--0 . ' - — • (Phone) COP- a- — 9 CD — 7 (
(Contact Name) `-TO' V\ S 1, v"---. (Phone) `? S 4 40 ° --/'62'
(Address) 3137 GNP-12A- ` k4- l -I -- 5
TYPE OF WORK ❑ New Construction deck ❑Porch ❑Re•Roofing Ole- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: !.R.C. ❑I.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ 1 c9
Occupancy Group: A B E F H I M R 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. 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
offtci. can revo ' is per it for dust cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. .
X i 'i eccap cfs 5 ( - 7 - a9 $ 5
Signature Contractor's License No. Dat
Permit Valuation 749 o®.- Park Support Fee # $
Permit Fee $ t 41 :LC- SAC # $
Plan Check Fee $ 15 .11 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 $ TOTAL DUE dwzp i ,G-,(2) $ - z--1 - 4, G
This Appli y on� . co s Your Building Permit en pproved Paid L Recei , t No. j iiit
�i �� i D ate �3 By ,
Built ing Official Da e
This is to certify hat t . equest in the atve application and accompanying documents ' i accordance with the City Zoning Ordinance and may proceed as requcsted."This document
when signed by C y •lanner constitutes a temporary Certificate of Zoning complia e d allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. �� • i „
l a r P FE
Plan ' i i - . ate Specia Conditions, if any
4 hour notice for all inspections (952) 447 - 9850, fax (952) 447 - 4245
4646 Dakota Street Prior Lake, MN 55372
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