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PRl3 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd�
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 'l
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(*j
NES��� I. White File /
3 Pink city PERMIT NO. /' � �/)` CLI
3 Yellow Applicant `� C1
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
\'—l '—‘k zo› .„...00z, e4- cc__
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID ar O`''6 4'
OWNER
(Name) (Phone)
(Address)
BUILDER Y1� 1x 1b'S ,�2a. \l1
(Company Name 5� (Phone)
(Contact Name) )2- b(Phone) k2- 23"1. s oq .
(Address) al)S 4C'r'�v"amu &'.)1 1J O O Vt..6 SS(S 6Cfi
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ['Re-Roofing re-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc. (f--
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ I P 0313
Occupancy Group: A B E F H I M R SU (excluding land)
Division: 1 2 3 4 5 I ,
I hereby certify that I have fhrnishe 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,igent for the
above-m oned property an tha ll 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 e ke this ermit j tjcause Furthermore,I hereby agree that the city official o a desir
gnee may enter upon the pi to perform needed inspections.
Signature Contractor's License No. Date
Permit ValuationPark Support Fee # $
Permit Fee $ 14. 7 SAC # $
Plan Check Fee $ QWater Meter Size 5/8"; I"; $
State Surcharge $ 5- Clip
Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $ _/J
Gas Fireplace Permit Fee $ TOTAL DUE q.
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This Application Becomes Your Building Permit When Approved Paid -76pcReceiptN
Date .0/4 By
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 Occupy ncy 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