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CPRiO� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Z� ` 7�
41, AND UTILITY CONNECTION PERMIT
ES��� I White File 4_ 577
Pink City PERMIT NO. / /
3 Yellow Applicant L
(Please type or print and sign at bottom)
ADDRESS ( NJ .i ZONING(office use)
L 0 E,LA, l th' 1 f 1i% \ 4
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER--(' -I TI
(Name) J t'✓`4r,. t'," l Vu,^P r.").-,.:- (Phone)
(Address)
BUILDER � ) t I ,
(Company Name) �v1y �� 1' 11Rh'S %^c, tit,, (Phone) q5 -z - �47j cr'�Cj "�
(Contact Name) QO� 0 (.a21,-.V.'4''` 1/ (Phone)
(Address) �t Z 641\1.4,r, c%t k.� " tom{`
TYPE OF WORK ❑New Construction ['Deck ❑Porch ZRe-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Mtsc / �7
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ lf+j^
�... O 0
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge nue and correct I also certify that I am the owner of authorized agent lot the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans I am awaie that the building
official c.- oke this permit for lust cause Furthermore,I heieby agree that the city official or a designee may enter upon the property to perform needed inspections
X 2ec t5e 36. 6 t,77i 6t
Signature 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 $
Gas Fireplace Permit Fee $ TOTAL DUE $
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This Application Becomes Your Building Permit When Approved Paid Jceipt No. 113 316
Date Co , (� `1`-�J .
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 Plannei 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