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(I- PRi.0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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7 x AND UTILITY CONNECTION PERMIT (/
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41A'NES):" I White File
2 Pink City PERMIT NO. / 4 6,L
i Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
I CY e-.3 F.ve_e__Auryt 4-Li — Al o
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID X25• a, .tiO 'C)
OWNER
(Name) S.
i" U 6z / t✓S i A k (Phone)
(Address)
BUILDER
e /
(Company Name) /!- Cern 5/yu�h'v�-. (Phone) q*"--'C.f "K3Z 1--
(Contact
(Contact Name) 6r'1✓e..jlL4,.5u;,.-, n (Phone)
(Address) (0 t'1 f 1 / /4,411- 511— Y►'►c;t e.„,,J:... 4141
TYPE OF WORK ❑New Construction Zeck EPorch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: I.R.C. ❑I.B.C. ❑Misc
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ q°"/
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 true and collect I also cettrfy that I am the ownct or authorized agent for the
above-mentioned proper and t t all construction 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 r o .this !mit , ist cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections
Signature Contractor's License No —.__ Date
Permit Valuation 0,� C C>6 U G Park Support Fee # $
Permit Fee $ '73. -7 SAC # $
Plan Check Fee $ 4t'7 !4Z- Water Meter Size 5/8", 1", $
State Surcharge $ t t,, t 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 eiht &b -7 e.,/4- , $ / 2_z___, c
•This Ap ti •ti/ Bec In,es Your Building PermitT
en proved Paid /1z, (v / Re pt No 7/ 7
-7_ /
I� i4V'\ 1 f Date '';' B
Building Official Date
This is to certify that the request in the above application and accompanying'ocume is is in accordance with the City Zoning Ordinance and may proceed as tequested This document
when signed by e C Planner consj`itutes a tempoiary Certificate of Zoni corn,lance and allows construction to commence Before occupancy,a Cetuticate of Occupancy must be
issued
Ai
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
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