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4.,,,ANc CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE a
`� AND UTILITY CONNECTION PERMIT �3 /
e ✓
`':ikN E S O,S
3. White File PERMIT NO. 14 167-1 3. Yellow Applicant �-t
(Please type or print and sign at bottom)
ADDRESS
ZONING(office use)
11 tl>1i) .barLf I ELI) 1D12-- R r
LEGAL DESCRIPTION(office use only)
LOT BLOCK 2 ADDITION CY-'-f-1 L:"4Z l/ \' r L ) PID C)?5:" '/�)7 032
OWNER ,,
(Name) FEIt1t DA*I RT (Phone) b1"1/11-11-1-1
(Address) I1'-o De.E►Z-110.-D on. PQIoi- IA ILE i-,\.IQ
BUILDER
(Company Name)PIkI DwcS (DREc,Stot.l iN.vv1E 1 N ouvemeivr) (Phone) en, ell - Cl`f11
(Contact Name) 714 It' MulZ- A (Phone) q5t-Zl5-6M6
(Address) 350u VIW.513v z-61 bN ,') ti '0L IPLYMOI.I1V MN 65`141
TYPE OF WORK ❑New Construction MDeck ❑Porch ❑Re-Roofing ORe-Siding ['Lower Level Finish El Fireplace
❑Addition ❑Alteration ['Utility Connection
CODE: aLR.C. I.B.C. 0 Misc:
Type of Construction: I II III IV V AB
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ .7V U v
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 p-. it for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
IBC 636111 .2 I— I N
Signature Contractor's License No.
Date
Permit Valuation Park Support Fee ## $
•
Permit Fee $ 6r,y. . SAC # $
Plan Check Fee $ 4 i'•t6O Water Meter Size 5/8"; 1"; $
State Surcharge $ , 8, 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 $
Ci4-4-4--•30 eA//14
This Ap./ . .,. Becomes Xour Building Permit Wh Ap roved P, c ` / 1-142D �®W r S Receipt No.
A 1 By
25.-
su t.inge� Date
This is to c ify t the request in the above application and accompanying docume is in cordance with the City Zoning Ordinance and may proceed as requested. This document
when sign a ity lanner capstitutes a temporary Certificate of Zoning comp ance allows construction to commence. Before occupancy,
issued. p cy,a Certificate of Occupancy must be
pili-„„,„....r--------, D e 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
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