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F PRIp CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
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•
cTEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT `( '��,
14
I. White File
���NESO2 z rink city PERMIT NO. I Li r a'
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
T G. office use)
5 9--9.g C 10 5�.�4cok 34. 5E 0.
LEGAL DESCRIPTION(office use only)
LOT COLOCK ADDITION 0&Ira '('\(-)..R \ A al PID af. ` pejo w 0
OWNER MIC,� lY i g' a &" (‘,05?
(Name) (Phone)
(Address) 1\
BUILDER ,,( /
(Company Name) t�(1fr� � (Phone) COSI i360('1 `LUQ-Fs
(Contact Name) (Phone) B(
(Address)nap Co .? ` .C" W,e_S � pSe�U>I\t i CON sS 11-5
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace/ ,
['Addition ❑Alteration ['Utility Connection . !lam/`i g- l�Aj' L �1 yl
CODE: ❑LR.C. ❑LB.C. IDMis a ► _ . . a I , .a `•.4I. .
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ / /� 31
Occupancy Group: ABE F HI MR SU (excluding land) 1
Division: 1 2 3 4 5
I hereby cert fy 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-menti. 'd property and that all'. ruction 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 re ke this permit for just Furthermore,I hereby agree that the city offic' or a designee may enter upon the property to perform needed inspections.
OP • AI 4111
-50.9 Ilvou ILL
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ ---7q, J SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ -, 00 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 $ `'l Cl 1
This Application Becomes Your Building Permit When Approved Paid 1 4/� Receipt No. l0 )
Date I t •as-- ( q By /`-t,(.,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 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