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f vR/-3 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A.0...\
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 6), 5, /
AND UTILITY CONNECTION PERMIT
v x
4/NNESCrit'
i White File
2 Pink City I PERMIT NO. (4.4 ,Lt79
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS oc _ \ � )/� g I
LEGAL DESCRIPTION(office use only)
L
LOT BLOCK 3 ADDITION ‘/C /e! z--..--54 -, - /--.4—� /SPID -- g6 03 —F)
OWNER Se9e1/adae
(Phone)
(Name) J jr
(Address) / '71 6 7 -y-.0,-2.76 C , 5, L %
BUILDER fto 2S,,rc,G SQQS(Phone) Cr, ��q3
ompany Name) .�/�/� X-�
(Contact Name) Y 6 1 t � ` CJS r_✓' (Phone)
(Address) �.J
TYPE OF WORK 0 New Construction ❑Deck ['Porch ❑Re-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
['Addition ❑Alteration ['Utility Connection /�� 5
Q�Misc _
CODE: DLR.C. DI.B.C.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have hurnished information on this application which is to the best of my knowledge true and correct I also ceinfy that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accoidance with submitted plans I am aware that the building
official can revoke this -mit r ill' ause thermore,I hereby agree that the city official or a designee may enter upon the pioperty to perform needed inspections/
Signature
Contractors License No Date
Permit Valuation
Park Support Fee # $
$ I / �J 5- SAC # $
Permit Fee "l
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 1 $
TOTAL DUE $ flqi
This Application Becomes Your Building Permit When Approved I Paid f r F Re
ce(..1 1%.;(3
Date �Y'
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 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