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Pi CITY OF PRIOR LAKE BUILDING PERMIT, C. Date Rec'd
OF 0+P
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �;
., AND UTILITY CONNECTION PERMIT
v ®v t�
M�ANeSO iti
2 Pink File
PERMIT NO. /
i Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
s-o C)rt..,DY.-��.o1_, C,-r. t,) � � POI)
LEGAL DESCRIPTION(office use only) to-Me `
1Q� A
1
LOT/C BLOCK( ADDITION,- /( 6U✓fi1 VI C/PID �J 3 �0 L - 0
OWNER
(Name) (Phone)
(Address)
BUILDER /
(Company Name) 1-70 L.,'D S-t1& C - ,,1...A \ ,t..,.x (Phone) (-,,,\D- ' 3c \. 4-3 s- -5
(Contact Name) -... /:=‘-c--`v 1^)"-s-)W-1.5 (Phone)
(Address) v\c)•--k 3.JP U,.aL.-JAA- t... ]rIz_. 3 Nea-F'v..--3 ..`L_) iv-r.-..1 C 3'-1`\
TYPE OF WORK ❑New Construction ['Deck ['Porch U'Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc d
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 83".
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 in authonzed agent for the
above-mentioned propelry and that all consnaction will conform to all existing state and local laws and will proceed in accordance with submitted plans I am awaie that the building
official can revo his permit for Just cause Furthermore,I hereby agree that the city official or a designee may enter upon the pioperty to perform needed inspections
X l L- )--16AD G C=-k, -s\ a S" '7- "6 • \%-\
Signature Contractor's License No Date
Permit Valuation Park Support Fee # $
Permit Fee $ --I /f Is- SAC # $
Plan Check Fee $ l� Water Meter Size 5/8", 1", $
State Surcharge $ 1 s (3 ' 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 $.--17., -i s
This Application Becomes Your Building Permit When Approved Paid -19. `� Receipt No. 3'7e
Date -7_ b I' 6 Lf- By ,Ml.t.
Building Olfictal 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 iequested This document
when signed by the City Planner constitutes a tempoiaty Certificate of Zoning compliance and allows constnrction 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