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o f VRIO CITY OF PRIOR LAKE BUILDING PERMIT, , Date Rec'd
( TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. white Fite PERMIT NO.
3 Pell Applicant
3 Yellow Appl itam
Please ■ or print and sign at bottom)
ADDRESS ZONING (office use)
'Al 0 4oAl( Ix' Nw , Cen c 1.E N ss -'9-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name (Phone) 1 A - .(.0 -. 0
(Address) WIOLt 6)(1 6 4' 1 ,,.\ R tl ►� (4,.a . 1-' '-- 1),
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction.eck ❑Porch DRe- Roofing DRe- Siding ❑Lower Level Finish 0 Fireplace
❑ Addition ❑Alteration ❑ Utility Connection
CODE: R.C. DI.B.C. 0 Misc.
Type of nstruction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U
(excluding land)
Division: I 2 3 4 5
1 hereby certify that I have furnished information on this application which is to the best of my knowledge taste 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 re oke this permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed mspecttons.
k� x c � ,, l0 , k-
Signature Contractor's License No. Date
Permit Valuation - ..- Park Support Fee # $
Permit Fee /3965. SAC # $
Plan Check Fee .' /_7 .1 � -6,s 10 Water Meter Size 5/8 "; 1 "; $
�" t 7
State Surcharge P&p -- 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 $, 1 2 - Z -r
Grp - it p � � � �" � � � '+ � � This Appl' atio , Be , i mes Your Building Permitit, ! )-L Approved Paid 6 . _ (( 3 Receipt o
r Date / /.S /tC3 By
uilding Official ate
This is to certify ,hat t e request in the above application and accompanying doc ents s in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by lie ' y PIa ner constitutes a temporary Certificate of Zoning c plia, ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
3
Planning Director late Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
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