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of PRI0� CITY OF PRIOR LAKE BUILDING.PERMIT,
, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
ell
AND UTILITY CONNECTION PERMIT
44NNE 5O.Ct
I. White File I PERMIT NO. "��
PCity
3 Applicant5 I
(Please type or print and sign at bottom) Yellow
ADDRESS
ZONING(office use)
3 -4-Li 1 , — a')Vc S Ill/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER /�' ,
(Name) ,�✓i 9- (� _
iJ 69.-LyyLi
�- / J (Phone) („��— /
(Address) 3 -y /✓/4,er ai ch ei Gi,i /44/ 5-5-3?-2_
BUILDER 1' _..._____
(Company Name) i'i T aWeirei 6iii 14^C--. (Phone) Cul 2.--2:2-0 ..-LCA t
(Contact Name) r.4. 1
(Address / itt (Phone) 6/ .-2.LJ —ZI,,C.,c1
)Z� 1rt _ Ca— eve /)p, ��, Mit/ 5-k, --3`
❑New Construction
TYPE OF WORK �❑ ration'eck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
DAddition ❑Utility Connection
CODE: [ IZ.C, ❑LB.C. 0 Misc.
Type of onstruction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ / 7c
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have tarnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the ownci<icaufho
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 for just cause. Furthermor I hervh t+std tient for the
y agree that the city official or a designee may enter upon the property to perform needed inspections.
X 6 3 3-3 0c.y
Signature I I�iI Date
Contractor's License No.
Permit Valuation
{e}6V-' Park Support Fee # $
Permit Fee $
r® ; .- SAC
Plan Check Fee / # $
$ �, ,Is Water Meter Size 5/8”; 1"; $
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
Gas Fireplace Permit Fee $
$ TOTAL DUE
$ r 7/- 7-
This Application :comes Your Building Permit When ppr n ved ir/Zy
Paid ( 7 I Receipt No.�ii,ifi4 .►/ I Datey' By
Buil;m l l 7
g ate
This is to certify that the re..test i t.e above application and accompanying documents is i ccor nce with the CityZoning Ordinance and may
when signed by the City ner,) statues a temporary Certificate of Zoning compliance d all s construction to commence. Before occupancy,acCwficat tot tOccupancyimust be
issued.
fi.
Plan 'ng Directa-"lIIIIIIIIII.
ate Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
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