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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
t- TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
or AND UTILITY CONNECTION PERMIT '7. t? I.- l
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I. white the
2Pink City PERMIT NO. /4i
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3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)1 Y 6246/1-M-(C/71 .R
LEGALnDESCRIPTION(office use only) r r-
LOT "` BLOCK3 ADDITION ( Q/, ?e /1/6 y PID J —4,49 0 3 -0
OWNERr / f
(Name) /' ` L/ 0(,t 9A (Phone) /O/ —4.- 4-V-, —�C
/
(Address) !6c'� .7p
BUILDER 7 � _
(Company Name) i _ 'A c %//' �) , -7�j
(Phone) ���� /0 9�0�
(Contact Name) _] ytrn !Tl (Phone) '' yd' ?v�:2
-7
(Address) ` 6 ! 3 LAK/--(3,/4 l Di1i , G(/ � A75s i5
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TYPE OF WORK 0 New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: DI.LC. DI.B.C. Misr. 1/ IAA id/7(l' S
Type of Construction: I II III IV V AB //
Occupancy Group: ABE F H I MR SU PROJECT COST/VALUE $ `j /C
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of know
pp� my knowledge true and correct I also certify that I am the owner or authorizedagent for the
above-mentioned . .‘.., and that 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 revoke 4 ... .'t fo cause. Fu.. . . -,I hereby agree that the city official ora designee may enter upon the property to perform needed inspections. ,
Signature
Contractor's License No. Date
Permit Valuation 4, /9 Park Support Fee # $
Permit Fee $ `� SAC # $
/Plan Check Fee $ i� Water Meter Size 5/8"; 1"; $
State Surcharge $ c CI Pressure Reducer $
Penalty $ 9 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 $ - /7
This Application Becomes Your Building Permit When Approved �� /it/ °� - Receipt No. � ,
Il ate _ B _
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 requested. 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 S.E.,Prior Lake,Minnesota 55372