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OtifPRIOCITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
���NESO I White File PERMIT NO. (1,41----;----17
2. Pink City
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
ala of'oe \ s E
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
`� i• )Q�')aa� . ,
(Name) u � �I �I �_ �� r (Phone
(Address) ,t3 o r 1e
BUILDER
(Company Name) 4\ c-*' (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New ConstructionDeck ❑Porch DRe-Roofing ❑Re-Siding ['Lower Level Finish CI Fireplace
❑Addition DAltera o ❑Utility Connection
CODE:( R.C. ❑I.B.C. El Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5 l
I hereb 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
a•.ve-m ,honed property and tha 1 construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building ,
ffi
) cial ca revoke this permit for ust c,Ise. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
• Si! , re Contractor's License No. Date
Permit Valuation ,jC�'Y10. Park Support Fee # $
Permit Fee $ (/7 '7 5� SAC # $
Plan Check Fee $ /lo �4 Water Meter Size 5/8"; 1"; $
State Surcharge $ 7 1 <0 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 $ /%0 41
This • . icat'in I> o •es Your Building Permit en pproved Paid (%../T Receipt No.74.... 5
Date7/4r1 By
Buildim_Official ,-. , D, e
This is to c tify that a request in the above application and accompanying docu ,ents is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when sig,b th Vi�ty Planner constit ` ••• - ry Certificate of Zoning co pliance nd allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued /
, til� . ) .
I
•:r • . or ).to 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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