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OO2HZF- a 0 0 0 u. u. u.= u, p.( 0 0000 ❑ U
of PR-i- CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. AND UTILITY CONNECTION PERMIT £`l /�•/4L
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+. !' 1. White File
NEg�� 2. Pink City PERMIT NO. _ •- .
—46r
3 Yellow Applicant , �)
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
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LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER bri ,r Kr/ /1/Y ' ' 7 (Phone) /` 3 s-77/0
(Address) 17' (1 6a/7 7 a Ole/
BUILDER r _ ,, G 2 Z3Z -3
(Company Name) 6y �//— 1 � � (Phone) 61
(Contact Name) %irt 20th 1 Fey-' (Phonee))�/
(Address) 173 i3 eQ7� 9) ,r7/0(___s /770 s
-S —�f/5
TYPE OF WORK 0 New Construction geek ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: R.C.. DI.B.C. ❑Misc.
•
Type of struction: I II HI IV V A B PROJECT COST/VALUE $ r�! 2-6V
Occupancy .roup: A B E F H I M R SU (excluding land)
Division: 1 2 3 4 5
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 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 for just urtherm e,I ereby agree that the city official designee may enter upon operty to perform needed inspections.
X ,
Signature Contractor's License No. Date
Permit Valuation 5'00 e5 O. — Park Support Fee # $
Permit Fee $ t t, ..,,C 5 SAC # $
Plan Check Fee $ 1 r„*S 4- Water Meter Size 5/8"; 1"; $
State Surcharge $ 7._ c° 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 $ ‘16 .1I 6
is---43R
This Appl'!do Becomes Your Bu#Iding Permit 7AP7ced Paid Receipt kir
Date c It?1 14_
By fitiC—
/4 �/i !ui 'Official
This is to certify that th equcst i, the abo/ application and accompanying docu nts is in a ordance with the City Zoning Ordinance and may proceed as requested. Tins document
when signed by the C nn-'i)nstitut, a temporary Certificate of Zoning co fiance an allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
1� jack 4 19 \
di-
Plan ing Director - Dat Special Conditions,if any
24 hour no ice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
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