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PR/04,
/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
z.)-, AIN2, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /"" AND UTILITY CONNECTION PERMIT
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'. White File
. PPERMIT NO.
3enk City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS , ZONING(office use)
L 265 ( v- & e C . yV
LEGAL DESCRIPTION(office use only)
LOT � ' ADDITION .S3115 24^-a PID
�� �-
(BLOCK PID
OWNER
(Name) l,.ik i rf V 4 ie.- V A C (Phone) r k,,,,A- ,p2,-,,ds,
(Address)
kft -
(Address)
BUILDER
(Company Name) ,e\d•- C" C741.1. 14( I S (Phone) i Z' Z-02-7.es 77
(Contact Name)
U(--*)v f (Phone) 95-1-' 1(9 Q- gpxo ,
(Address) c"�I C( 1-c- 124 , G. k✓.AS) Ile CVs ,S- 331
TYPE OF WORK 0 New Construction gleck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection p 0 �� "
CODE: 2R.C. DI.B.C. IrMisc: M) ST-A-1)--,5 .---D PA-110 e:
) �
Type of Construction: I II III 1V V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ 1000 _
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished info to .n 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 ons%A.•n 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 fo ' st cau . u - • :,I hereby agree that the city official or a designeemayenter upon the property to perform needed inspections.
X
J3c63/Jk
9Signature Contrtor's License No. Date
Permit Valuation LI-W, ,.. Park Support Fee # $
Permit Fee $ �7;v SAC # $
NJ
Plan Check Fee $ 3 2.0 Water Meter Size 5/8"; 1"; $
State Surcharge $ ,1 G Pressure Reducer $
Penalty $ l 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 DUE019/V /Z ' /,14— $ fes) (
y c�/
This App` ati•. :ecomes Your Building Permit Whe Appr ed Paid 0.2./ Receipt No. 7.2598
i1 / >, Date / 00=19 By �GcIL,
E r, /a 23 1'f
Building Official Date
This is to certi that the request in the above application and accompanying do. ments' in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed' e '. Planner constitutes a temporary Certificate of Zonint compli. ce and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
ilea (co 2
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
CITY OF PRIOR LAKE
Impervious Surface Calculations
(To be Submitted with Building Permit Application)
For All Properties Located in the Shoreland District (SD).
The Maximum Impervious Surface Coverage Permitted in 30 Percent.
Property Address /'/z 6 8 f c k v e C6 u r+ t i-)
Plati �cd I h P { or°.5ec)
Lot Area 6, 5-6 ti Sq. Feet x)00 = Z6z5
************************************************************************
LENGTH WIDTH SQ. FEET
HOUSE x =
x =
ATTACHED GARAGE x =
TOTAL PRINCIPLE STRUCTURE /1/ ?•
4
DETACHED BLDGS x
(Garage/Shed) x
TOTAL DETACHED BUILDINGS iV/4
DRIVEWAY/PAVED AREAS x =
(Driveway-paved or not) x =
(Sidewalk/Parking Areas) x =
TOTAL PAVED AREAS 7 Z
PATIOS/PORCHES/DECKS x = 6 9
(Open Decks''A"min.opening between x =
boards,with a pervious surface below,
are not considered to be impervious)
/ d' x / Z = ZI ( Decr)
TOTAL DECKS z 8 5-
OTHER x =
• x =
TOTAL OTHER
TOTAL IMPERVIOUS SURFACE s 1 Z.
UNDER/• R 113
Prepared By C 04-9r x c e << Date t d— t 6 - i V
Company Probe t.,-er-; i) Ce., i.c.)c_ Phone # 'j 5-2-- q3z— 3Cod
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