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PRIpCITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT �o, /0, llr4j
q�' I. White Filer�rrEso 2. Pink City PERMIT NO. /4` //1;,111*
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
141 -\3 V‘s\-,e_x �\) Q i\) lel
LEGAL DESCRIPTION(office use only) f
LOT A BLOCK /if ADDITION 44 Ia /%Ja/e 5/w,& )mss PID 075- Ds$003-6,
La NO� (Phone) 5 '7%- I%9O(NaWNER (�me) VA'c���
(Address)
BUILDER c !i t;
(Company Name)1�Z1`€Q111)C%. Cai )(512, (Phone) / --0 0 ' v
(Contact Name)QlQ �M (Phone) = - �� k
(Address) 112,0 CO • "C- t' S� � N 66(LkM \€g 11 1 I J SS''3
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ['Re-Roofing ❑Re-Siding ['Lower Level Finish ipi Fireplace 4,v
['Addition ['Alteration ['Utility Connection VA,CI S IA/1lyd CANS W J,Yl—CJ T 1
CODE: ❑I.R.C. ❑I.B.C. S
00
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 7)9'9
Occupancy Group: ABE F HI MR SU
Division: 1 2 3 4 5 (excluding land)
I hereb certify that I have fern -d 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- entioned property a • th 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
officia an revoke permitfor cause. Furthermore,I hereb a:ree that the city officialfsige may erg u n t e property to perform needed sponl�
X 1 ?)C,\
`1J�(L�
Signature Contractor's License No. Date
Permit Valuation c Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ a Water Meter Size 5/8"; 1"; $
r
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $ /l_
Gas Fireplace Permit Fee $ TOTAL DUE / $ lg 2. 5
This Application Becomes Your Building Permit When Approved p i I q ( Receipt NO. (�
t0 ` t0 , (� By D
Building_Official Date a****.....
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