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- O/ PR/04,
ti 9 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
tri TEMPORARY
UTILITY CONNECTION PERMIT
'jrlNNES°•C
2 White
City PERMIT NO. l 4_ 4'---
3.
' —3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(off re use)
3 7 73- 7 U rj1 tc p( Se-)i fr u/- 1.49-IC,. NIA/ ss 372
LEGAL DESCRIPTION(office use only)
43 / 171.;.c-Kory S '-4( C-
LOT BLOCK ADDITION PID
(N WNER .S I eif<-r+ 9t .8413/1P/9 ,_18 r veyil) (Phone) ‘0-,5-96.ccO -CCZs /
(Address) 377C C ///r n c - /AZ. S:,/ A-,,,,,- L-?atm. /140✓ 5 S
f
BUILDER
(Company Name) ()w/1 G vr. (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction 20:Wsck DPorch ORe-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
DAddition DAlteration DUtriity Connection
CODE: I.B.C. DI.B.C. 0 Misc:
Type of Construction: I II III IV V A B
Occupancy Getup: A B E F H I M R S U PROJECT COST/VALUE $4 4/Z-00< O(,)
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 correct. I also certify that I am the,timer or authorized agent for the
above-mentioned property and that all will conform to all existing state and local laws and will proceed in accordance with submitted plans. Dim.aware that the building
official can for just rause. ore,I hereby agree that the city official ora designee may enter upon the property to perform needed inspections.
X
—
rgna Contractor's License No. Date
Permit Valuation 0000 -- Park Support Fee # $
Permit Fee $ f‘PZ- " SAC # $
Plan Check Fee $ ( -;U Water Meter Size 5/8";1"; $
State Surcharge $ 4, . 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 $ Z Z I .3 O
r ?],/'
This App• on : . ,: ,�x, .,, " ,_:Permit Paid 7i ��'�J Receipt No. � � "j�f
Date 'l ( r 4_ By b t
c� `-
:w,i •i cial Date
This is to certify •, th- •nest in the above application and accompanying•.. ,, is,,accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by i, ',,,,- tea a temporary Certificate of Zoning comp' -:and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued )1I +', ' .
g
lag Directs ��► a.i, Special Conditions if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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