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OF Pions CITY OF PRIOR LAKE BUILDING PERMIT, ' Date Rec'd
r.
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
i
AND UTILITY CONNECTION PERMIT 4-.1i5„14.-
I White File
y/NNESOS� 2 Pink City PERMIT NO.
iLt . -z7
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
3433 \ S rfl 5 S. L01
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Lem
O I Ste- (Phone) /v a — tic/6 —1903
(Name) l.�
/•,
(Address) I
BUILDER
(Company Namey_e, , !` Q (Phone) IUS/-acah1 - 7o l
(Contact Name) 1 1 a d CO , , ,C.t C le.
�-- 5 (Phone)
(Address) ._'\1e, 1�� SS 11'2,
TYPE OF WORK 0 New Construction ['Deck ❑Porch DRe-Roofing ■Re-Wing ❑Lower'Le_vel Fini h ❑Fe lac
ire -AD
['Addition ❑Alteration ❑Utility Connection - Qk.Cr2 1 LolA ,uv`"-' l
❑Misc 4P� �2/YN (�
CODE: DI.R.C. DI.B.C. rS�ll^Q Y t�114749
�/
•
Type of Construction: I II III IV V A B
PROJECT COST/VALUE $ �� L 47�
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby c• ity that I have furnished information on this application which is to the best of my knowledge nue and correct I also ceuify that I am the owner of authorized agent for the
above-m toned property and th •II constriction 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 revoke his pet mit f cause Furthermore,I hereby agree that the city tial or a designee ma enter upon the property to peiform needed in, ections t
X •:• ► so, c ) O g3 ao (i ) JU
Signature Contractor's License No ate
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 t $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid 11'1'S , / Rpt No. 1114°
Date 'j . LS 4( 1 B
Building 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 pioceed 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