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0 PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, el
Date Rec'd
L\\
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT it Z` t y
--y,
t.whillit Filn PERMIT NO. /9. 7 13 Y
py . J
3.Yellow Applicant
(Please;type or print and sign at bottom)
ADDRESS 1 50 4o cl(cc, 0a(S Tr o.k...I S U' ZONING(office use)
LEGAL /j ✓
DESCRIPTION(office use only) Y - L
LOT j BLOCK ADDITION ' e,i 04 1 S PID t�
`/ "cc zi-
OWNER �^�^
(Name) weft ley di tnt BG rbpt ra. M.O v r it'IAcj i (Phone) q5 Z - ' 7-3 Z ,5
D
(Address) I.56 4 67 rrcv) Oak S J ail .55 E %f';or Lake.y ,M/J 5535c _
BUILDER
(Company Name) S tin C tSe_
Re toG�.�i t •a
(Phone) 651-76 Z - 9Z`I
(Contact Name) J-4,6(tt 11 pi✓ e, t� (Phone) G S I- 76 2 - 9'Z?5
(Address) 5'176 tit t/e La-0u– . I• Paul J4Ii 55 110
TYPE OF WORK 0 New Construction DDeck DPorch 'Re-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
CODE: DI.R.C. DLB.C. 0 Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F II I M R S U PROJECT COST/VALUE $ J d j 0g 1. 7q
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 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 -. .r . e use. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x 1 ,> , ► C.t205 rS I g 7- L 0 4l4-
Signature Contractor's License No. Date
Permit Valuation / Park Support Fee # $ •
Permit Fee $ r SAC # $ •
Plan Check Fee $ � I`' V Water Meter Size 5/8";1' $
State Surcharge $ `' 6 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 $ T 0 AL DUE $ lq ( S
This Application Becomes Your Building Permit When Approved 'aid ' 1 ei `i .. Receipt Nol I Ci 01
Bate f. By
LI t
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 requeste . t nts ocument
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 1
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372