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pu CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
(.-i-
'` TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
,w; AND UTILITY CONNECTION PERMIT /0.10 . ,
mow: g4,�'NESo1P •
I. White File PERMIT NO. /2../ l�2. Pink City
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS / ZONING(office use) ,
/ 7/ 3 f Sun5ti7� 4v ' uL
/Ls.,6
LEGAL DE,,SCCR/LLI��PTION(office use only) • .
LOT BLOCK ADDITION PID'5'rga-00 L7
OWNER L ,,, ,1 5 / < S Ct' fL► 7/ (Phone) q 52(4/YS'. 2 Q 77
(Name)
(Address) / 7 / 3 / 51.in51.. ( / 1- VC i) l/ G
(Co DER Pella Northland 9'52534/C. 6 0 Y1
(Company Name) 15300 25th Ave N. Ste 100 (Phone)
(Contact Name) Plymouth, MN 55447 (Phone) 0 Cit
(Address) Lic#BC645090 Ph. 763/745-1400
TYPE OF WORK ❑New Construction •['Deck DPorch ❑Re-Roofing ❑Re-Siding ['Lower Level Fint h 1:1Fireplace J
❑Addition ['Alteration ❑Utility Connection 3 w t A dd c.J Pip!7 ia u Ai itiL s /n
CODE: ❑I.R.C. ❑I.B.C. ig Misc. 1 V/2 141 61 L n OP t o , f
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 5- V 8 t .
Occupancy Group: A B E F H I M R S U ,
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 coma. 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 permit forju cau e. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspectijns.
/i C , el 7tify
• Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee //� r 7 SAC # $
Plan Check Fee $ �r'j Water Meter Size 5/8"; 1"; $
J U�
State Surcharge $ Pressure Reducer $
Penalty $f 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 $ 19' '
l f
This Application Becomes Your Building Permit When Approved IrT Receipt NO. , d
Date to 10 . / By
5
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