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�F PRt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
( TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �j
AND UTILITY CONNECTION PERMIT 7. Z6, `6J
41n0Nesoll' C.,,/ 1 White City 2 Pins. city PERMIT NO. /3 /0 7,
Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
Z 07' mLr4 t() - (j 3
LEG \I, DESCT ION (office u se only)
LOT BLOCK g ADDITION PID , -99/- C /--- o
OWNER ice /
(Name) / O 4 n ( S ✓ ''J / 7 (Phone) ���/ 7 2 < 2 P
/ � f
(Address) / l 2 / `� / a . ,. ` `_
BUILDER
(Company Name) P�J Ju!. 4 C C /� y / J
-� -C (Phone) �l 7 - Z.
(Contact Name) U ii k_ (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ['Porch e- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 • 5
I hereby cer that ave ht I `ot �on on this apph ton wh - h is to the best of my knowledge nue and correct I also ceinfy that 1 am the owner or authorized agent for the
above -me i e. .ro. -ty . J. c o j ruction will co. /� to at •xuttng state and local laws and will proceed in accordance with submitted plans I am aware that the building
official pe ea u u" hermore�tt r. • ee that the city official or a designee may enter upon the property to perform needed inspections
i / i
7
• ignature Contractor's License No Date
Permit Valuation Park Support Fee # $
Permit Fee $ . y % , SAC # $
Plan Check Fee $ / / Water Meter Size 5/8 ", I ", $
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 I $ TOTAL DUE $ t /s This Applic, i 1 ' ecomes Your Building Permit When Approved Paid l 6/ 71 il
ceipt No. I U 10I 'f� 7 1,3 Date n Z 7- (-S
B ;71117, 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, .1 Cctuticate 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