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of r>Rt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
( f g, TE ORARY CERTIFICATE OF ZONING COMPLIANCE
• . ; x AND UTILITY CONNECTION PERMIT / ' Z /_
4/�'NESo.� I. White File j' PERMIT NO
�' 2 Pink City (3 / / 7
3 Yellow Applicant r / 7
77
(Please type or print and sign at bottom)
ADDRESS R.1 Z (oFFice use)
t52 Qv go � 0rd to t
LEGAL DESCRIPTION (office use only)
LOT 1 BLOCK ADDITION +4/%Ali:
' / r' PID _ . _ 0 /-0-.
O(NameWNE) R 8 ro a 6 0 n Q 6e, (Phone) r 2 / fG - °5" 0 7
5 f ,,/
(Address) / 5 07 ? 0 / T O („) Q r CL 4(Q 6 ie 0 Q' ( Y �
BUILDER ' Pella Northland 92 Sys.- G 0 V 7
(Company Nar (Phone)
15300 25th Ave N. Ste 100
(Contact Name Plymouth, MN 55447 (Phone) C C�,
(Address) Lic # BC645090 Ph. 763/745 -1400
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe- Roofing ORe- Siding OLower Level Finish 0 Fireplace
❑Addition DAlteration DUtihty Connection / /
�S c » C/ O LJ P l 0 CA /Y) e M S
• CODE: DI.R.C. DLB.C. P
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ 2 4, 7 3 L
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 1 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 revoke this it for just use Furthermore, I hereby agree that the city official or a designe� may enter n upo the property to perform needed o mspe bons. 2 �1
Q need;
/�%
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 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 $
This Application Becomes Yo rid �
ding Permit When Appr ved ' ,s f(P' • Receipt No.
late 7 By
Buildime. Uni 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
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