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1 PR/0� CITY OF PRIOR LAKE BUILDING PERMIT, 0/ Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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AND UTILITY CONNECTION PERMIT
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���NES��� 1 White File
2 Pink City //
PERMIT NO. lam,/ 3
3 Yellow Applicant I
(Please type or print and sign at bottom)
ADDRESS / to
7 c / 8 // 1) d ZONING(office use)
J [ 77-4 R i cls
LEGAL DESCRIPTION(office use only)
LOT /BLOCK 3 ADDITION Pit'I G1/f:i 2 ')(' �' 16' PID•i,J 0/ 7--- A -0
OWNER /1 a U 1 d SCA A t)-L l G s 4/ 7 - 8 (2
(Name) �,/ [ � (Phone) T
(Address) ( L 7 5 / 81,i) d Z a t(.. 'Tr a (/
BUILDER
(Company Name) Pella Northland (Phone) `l S X 13 /1 ' L ( V 7
(Contact Name) 15300 25th Ave N. Ste 100 (P ) J b els
Plymouth, MN 55447
(Address) Lie#BC645090 Ph. 763/745-1400
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe-Roofing [Me-Siding ❑Lower Level Finish 0 Fireplace
['Addition ❑Alteration ❑Utility Connection 9 G,1 4 do u r(pia (,L le)L A-/s /4
CODE: DI.R.C. DI.B.C. IX Misc _1 Yl t; II/ I n/a/A /n e J
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 13 ! 9 L
Occupancy Group: ABE F HI MR SU
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished mfbrmation on this application which is to the best of my knowledge true and correct I also ceitity that I am the owner al authorized agent for the
above-mentioned property and that all constructs n 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 fox t cause lir rmore,I hereby agree that the city official or a designee may enter upon the property to peiform needed inspections
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Signature Contractor's License No Date
Permit Valuation Park Support Fee # $
Permit Fee $ 7 LL1 SAC # $
Plan Check Fee $ C;4.7 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 $
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Gas Fireplace Permit Fee $ TOTAL DUE $ ,l q c
This Application Becomes Your Building Permit When Approved l" • ✓ Receipt No. ...
---i Date l 1 ;(By � 3 -
Buildinupcial
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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 iequested 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