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o4 PRI �P CITY OF PRIOR LAKE BUILDING PERMIT, ' Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
U trl
,y' 4P I. White File PERMIT NO. 9,:/--7---1
NNESO z pill App r �
3 Yellow Applicant
(Please type or print and sign at bottom)
ZONING(office use)
ADD1jESS
4'°2 ( �''' � (-;///' 5e, efkr Zi52e 1
LEGAL DESCRIPTION(office use only) o
LOT BLOCK ADDITION PID".6-O/6aVO
OWNER ArrAIWAFAir (Phone) ��f� -/ ?(Name) ,
(Address) GG( ' 4 6t € ILt �" ®v z/7,
BUILDER Company ,, ,,e,,,,‘!r (Phone) 93- 6 ( -G' k�
(Company Name)2 14/'
(Contact Name) ij �! .y-,z.rli� (Phone)�s ..-,69.0.,C.!
r��
(Address)
TYPE OF WORK ❑New Construction ['Deck ❑Porch We-Roofing ['Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration DUtility Connection
❑Misc.
CODE: ❑I.R.C. ❑I.B.C. �f ��
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ �� �'v
Occupancy Group: A B E F H I M R SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have punished 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
ahove-ment.. • .ro.crty and t at all c t traction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware than the building
offici, an rev e t t permit .r j st u -. Furthermore,I hereby agree that the city official or a designee may enter u on the property to perform needed inspections
tgnatur, Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ q1-175-
1- !5- SAC # $
Plan Check Fee $ / L Water Meter Size 5/8"; 1"; $
State Surcharge $ C' OD Pressure Reducer $
Penalty $ ) v 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 $ I r -
This Application Becomes Your Building Permit When Approved Paid —2q, 7 I Receipt No.igj / L1
I
Date c- f-14/ 1 By ft)
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