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of Fitton CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
400,EScAP 2 PikWhite City PERMIT NO. I _�3 3
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/ C,°1 C—kJtorri C�F Pv40 0-14 I Sb
LEGAL DESCRIPTION(office use only) ,/
LOT (BLOCK /
/ ADDITION (M/ /4� 2 )/V PID �J'o7� 9--
�� (j
OWNER i
(Name) �f. ✓ `C'o v rt5 (Phone) CO I 7't11 —16 9r
(Address) 1 LICAO C -tecrf riot 0-01 0 572
BUILDER
(Company Name) 5/% 0PiE (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction (gbeck ❑Porch ['Re-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ['Alteration ❑Utility Connection
CODE: K1.R.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ �`$00.OQ
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I hay-. :, is"rd 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 ager t for the
above-mentioned pr• rty a.: at all construction 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 revo - is. it •r just cau Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
gcow-
Signe Contractor's License No. Date
Permit Valuation Z - _ Park Support Fee # $
Permit Fee $ 58 SAC # $
Plan Check Fee $ C7. 3c, Water Meter Size 5/8"; 1"; $
State Surcharge $ t, To 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 D $ 147-
.
47- ,
This App' ati' t Bec.!. es Your Building Permit • 'pproved +� /'�/
' Receipt Na. i
II ate / 1(7_ l f By 9A
Building°tticia D.te t
This is to certify that th•requ•st in the above application and accompanying doe en is in accordance with the City Zoning Ordinance and may proceed as requested. This dccument
when signed b the Ci Plat er constitutes a temporary Certificate of Zoning c mpf nee and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Planning 61 emu. 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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