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bPitio CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
iAND UTILITY CONNECTION PERMIT 1l. 0z. /3�,
44NEsoo� I. White File PERMIT NO.
2. Pink City /3 /2_7/
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
! c, g5V r/nz Av�4i) uc 64A)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID 5'34"adz-- d
OWNER 4bt ! /44 Gi'E 10 -41 (Phone) 96.2 L I?9b • td 60
(Name)
(Address) /Cs ! 51 1 rim, fc 1/4A Li e S W
BUILDER
NaPella Northland
(Company 7 CO YS - Co Y Nam (Phone) 7
15300 25th Ave N. Ste 100 J a O '
(Contact Name) Plymouth, MN 55447 (Phone)
(Address) Lic#BC645090 Ph. 763/745-1400
TYPE OF WORK 0 New Construction ❑Deck [Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition DAlteration ['Utility Connection / n
CODE: DLR.C. DI.B.C. D Misc. /O? 14 1 n do 13 Pop ( 0 "P21
Type of Construction: I H III W V A B( a/4 Cep w S ! t A V n/f e X W i/3 if o/l'11,
PROJECT OST/VALUE $ .2
Occupancy Group: ABE F HI MR SU (excluding land) 8 7
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 correct, I also certify 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 accordance with submitted plans. I am aware that the building
official can revoke this permit for us ause. Furthermore,I hereby agree that the city official ora designee may enter upon the property to perform needed inspections.
, .......... .:"'" h t. tti s 0 to Pi 7 / 3
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 $ 79, 7
This Application Becomes Your Building Permit When Approved Paid '7_9 /s Recei N . 7
Date ////43 By< -ti.,,,L,/
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 Prior Lake,MN 55372