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o� PR IonAN,e, CITY OF PRIOR LAKE BUILDING PERMIT, l/ Date Rec'd
ti ` RARY CERTIFICATE OF ZONING COMPLIANCE
TEMPO
AND UTILITY CONNECTION PERMIT
A'NESD
I.White File
. PPERMIT NO.
3. nk City k [� r 4l`
Yellow Applicant 7 1
(Please type or print and sign at bottom)
ADDRESS ZONING(of ice use)
2�C� ;Ic NWFrio( Lamy' S�3�2
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER �',r. 2 (.1 _ (Phone) (QIZS( 9 \i7-9
(Address)
BUILDER ��/ r 6,5-Li0V--(401{c1
(Company Name) Cyr-eSi- ,)(4e0ors, LU--l� (Phone)
(Contact Name) /Ac\' LA Gk.-- (Phone)
(Address) (2,125R2... Ch 1 p mCtaL A'i-e.„- imoa-t'OIN/1/).A/i SE 2 M
TYPE OF WORK 0 New Construction ❑Deck ['Porch le-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: WI I.R.C. DI.B.C. ❑Misc:
Type of Als : traction: I II III IV V A B2
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ )1G1`.)5 0�'
L
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished inform. '•• 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 co. tructio 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 rev.ke permit for just caul Furthe ,• -,I hereby agree that the city official or a designee ma enter upon the property to perform needed' ections.
ignature i Contractor's License No. Date
Permit Valuation 54) Park Support Fee # $
Permit Fee $ 14-1 K SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ ^ Pressure Reducer $
"7
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 $ 1 -'1 S-
This Ap ti o Becomes Yo Building PermittelApprOVed Paid Receipt Nr
7c
Pd.- ‘A"--1 I l
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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