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OF PRis� CITY OF PRIOR LAKE BUILDING PERMIT, (v Date Rec'd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE LI
'3 tri
x AND UTILITY CONNECTION PERMIT i / /
41/4NESOlt* I Whue Fde
2Polk City /�-f �
PERMIT NO. , /
Yellow Applicant /
(Please type or print and sign at bottom)
ADDRESS l /� -P
n ' / ZONING(office use)
/(ii?i( Jja04�Da R.-b A /AL x GA'K�M , -C.3-22 iii I S
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION TV /`eek-16"( C( 46 PID4"f— /c// (`)% I/--/
OWNER �}•p
/y
(Name) /�. 44 6201- -nJQ K09� C_ F G'.!�✓" (Phone) 9 - 2" a - 5-7 d 2
(Address)`L) UD7 R%A.Db p, 7-1.;1 J 14) T' �41,g-46- ,.<3-7
BUILDER L—A
a — 7th`
(Company Name) �"� (Phone) ' J
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction [Deck ❑Porch e-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
DAddition ❑Alteration ❑Utility Con ection
CODE: DI.R.C. DI.B.C. 0 Misc
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ ��U-"®
Occupancy Group: ABE F HI M R SU
(excluding land)
Division: 1 2 3 4 5
t heieby ccrtI
iat 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 01 authorized agent for the:
above menti property and that all cons, ction will coy orm all existing state and local laws and will proceed to accordance with submitted plans I am aware that the budding
official canee this per, it f. lust c use rthermefe, hereby a:,-e that the city official or a designee may enter upon the piopetty to pet form needed mspecuo s
III
..., AIM eb i
Signatu�- Contractor's License No ate
I
Permit Valuation Park Support Fee # $
Permit Fee $ "7i ,/J - SAC # $
Plan Check Fee $ Water Meter Size 5/8", I"; $
State Surcharge $ ,Cr 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
Gas Fireplace Permit Fee $ TOTAL DUE $ it it
This Application Becomes Your Building Permit When Approved i'--- ldqRecei t No.
s- �_ fir ? � � Date _C, 12- -- IL(- By ^
Building Off tal Date
This is to certify that the iequcst in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as iequcsted 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