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ot.fPR1oCITY OF PRIOR LAKE BUILDING PERMIT, Dale Rec'd
4. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
,�. 0, AND UTILITY CONNECTION PERMIT
Vm
4/NNESdoP i. White File PERMIT NO. ( 4.,_(0,6-
2. pink City
3 Yellow Applicant •
(Please type or print and sign at bottom)
ADDRESS ,L ZONING ;office use)
/(0(:)q9 & ii - i / Pays kr6,,u(
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER (Phone) )6 i' q7(17(Name) bZt� 5� � (Phone)
f (Address) ' G' 12cz.rz arr. `Vaks;, 5/l71-Co PC Nn/ SS'3r2'a_
BUILDER
(Company Name) 5A—p4e (Phone)
(Contact Name) (Phone)
(Address) •
TYPE OF WORK El New Construction /:Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alterat on ❑Utility Connection
CODE: .R.C. ❑I.B.C. El Misc.
Type of t struction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R SU (excluding land)
Division: 1 2 3 4 5 l
I hereby certify that I have burnished 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 'I conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
"„)........
offici. .n revokes permit f. jt +use. 'U ore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X PP- ior Vit/iy•gna re Contractor's License No. Da
Permit Valuation —ae i Park Support Fee # $
Permit Fee $ ,)' ,�- SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ L. - 57
Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's De osit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ f4f 7.f '
This Appli 'on. •comes Your Building Permit Wh n A t. oved Paid \ 14 if1( « 1 (*. '''''.if
No. /
Date By fq(k
Building Of lc. Pate
This is to certify that the re. est in the above application and accompanying do men is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by J`•Cit PI/ner onstitutes vemporary Certificate of Zoning ompli nee and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. /
' .nnmg 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
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