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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
r~4AIN TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
drf ' '
PATES°
1 White File
2 Pink Gty PERMIT NO. 14 t 304,
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/7 42/5l//% 'r 7/ 3.-E.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER, p
(Name) //0'Y/ 1.2A-51-7A (Phone) 95: -9/ 6&6 7
(Address) /?0? ,:a/d�x,.� 67/ s'. ,
BUILDER � � //11 �,,�
(Company Name)4)/Y7 .14./ 6i'71, j�i'//9i',00-'7% (Phone) S`-1 - -$-
(Contact Name) ;'�2, (Phone)
(Address) 5j/ /.9.. 5�Jiez,7 ,'S/ ~$f/ 17
TYPE OF WORK El New Construction ['Deck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition ['Alteration ['Utility Connection / /�j�� /
CODE: ❑I.R.C. ❑I.B.C. Misc: 41,4GfGk.)""`�°l�eE 4
Type of Construction: I II III IV V AB
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ ..f'd i
Division: 1 2 3 4 5 (excluding land)
I hereby certify the hay` en ed .'e mation 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-menti eye op a that.i 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 ca •. .erg/fo c se. Furthermore,I hereby agree that the cityofficial ora designee may enter upon the property to perform needed Inspections.
iir
Sign,• re 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 $ S
Gas Fireplace Permit Fee $ TOTAL DUE y$
l
This Application Becomes Your Building Permit When Approved Paid "1 4k '7 I(/.6„jI Re t No. 6„
Date 5. 2,,,! 474 By
7
Building Official Date
This is to certify that the request in the above application and accompanying documents is m 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 S.E.,Prior Lake,Minnesota 55372