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o ,P� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
N 1 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Z i v
t' AND UTILITY CONNECTION PERMIT 9-`
. ykIvES
1.White File
2. Pink City /®S?.PERMIT NO. 1� '7
—
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS Z7JG(office use)
4-1 "9- z- Tay 14" 0(/' Dr SE (
LEGAL DESCRIPTION(office use only)
LOT I BLOCK-2-- ADDITION ZOOC / C� tfr -3*4 cal l 477513 /�-'12 ,--
OWNER l' A N d. g-r I s y d io ry
(Name) (Phone)
(Address) jam' A✓rt E :,.
BUILDER /
A°
(Company Name) /t* g e 'e d/ 1. ''j (Phone) G/ 2 - 7 it) • 0,1 f
(Contact Name) P14 - 6 0 /i 4 (Phone) q5 7. Z Iv• $ff g Y
(Address) 7-6 7-5 All 13 'V SoLle 01/I `
TYPE OF WORK 0 New Construction ['Deck ['Porch ['Re-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: DI.R.C. DI.B.C. ❑Misc: Peck-- etoor - /54.441 rte TotQ
Type of Construction: I II III IV V A B O.
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ ?Poo
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 owner or authorized agent for the
above-mentioned property,*that all ction ' 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 perhit for lust ca Furth ore,I agree that the city official or a designee may enter upon the property to perform needed inspections.
X cr. 6 3q-' 12- ' eV?4/iy
Signature Contractor's License No. Date
Permit Valuation '--;-
� Park Support Fee # $
Permit Fee $ 47' SAC # $
Plan Check Fee $ I CQ-Z> Water Meter Size 5/8"; 1"; $
State Surcharge $ .— Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ c '�> Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 4c7 , , 7-‘*
, 7-‘*
This licati Becomes Your Building Permit ved Pai (d 7( Receipt No. P7 ' SI KM
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This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Planning Director Date 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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