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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 7- 0-9. ' Y
. i.White Pan
2. Pink City PERMIT NO./ C ‘. 1-7
3.Yellow Applieaar
(Please type or prod and sign at bottom)
ADDRESS ZONING(office use)
SA 1 sGliCiftiVIOVIrreO:l 5L i 6,21
LEGAL DESCRIPTION(office use only)
LOBLOCKe?' ADDITION Pr /a.... Jitti i(.., PID,,3,5--/-79- g 7 •-0 .
OWNER
(Name) /\ 4Ot4/ ' l.GO,. .0,14 (Phone) q 51- Si3 -35134
. i <-..... -,_„.-,
(Address) 5 79 1 Sirta..4 vio t.1. Tva;I 5E , Prior 1,14-Le.... MN ,..) ,5/ ‘,.._
BUILDER
(Company Name) GO(1Pr-Se Re 0--toolelv-5 (Phone) 651.-762.
(Contact Name) -Toe( )2e feLs 0 f....A (Phone)
(Address) 5.'176 t--)vb e 1..a 0_0_ S4 , Pao 1 ,444 $5110
TYPE OF WORK 0 New Construction ODeck OPorch VIRe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition DAlteration OUtility Connection
CODE: D.R.C. DLB.C. 0 Misc:
Type of Construction: 1 II HI IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 8i, 60767
Division: 1 2 3 4 5 (excluding land)
I hereby certitY 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 properly 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 perm '.• ., - ' Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
„...— -
1,---------
X 11.A-1 cRos i 516 8'- vg-14-
Signature Contractor's License No, Date
Permit Valuation Park Support Fee # $
Pt:twit Fee $ 78. 15" SAC # S
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ 5.--;0 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ , /7 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE
$ 29: ..-C..........:
This Application Becomes Your Building Permit When Approved
Vaal I_C\ -15 Receipt No.
te 7.A tk, By
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)447-9854),fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
. .