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* rRioR CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd •
h TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
11,
AND UTILITY CONNECTION PERMIT
44Nesolt• I. White File PERMIT NO.
2. Pink City /3-?,OD
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
I 41 1 &'Dvi 1v �,Vt % "3-72
i ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)OWNER p1/41 a In v_ A,'" (Phone) '"1 'z-260 0 ;5 D
(Address) J 4-tel b I okekot l e Ave sr
BUILDER //����//,�� 1n/� /�
(Company Name) C lv11 1 t ?L Co /�{c (� �,� (Phone) "/�/SZ-Z�r 2 /?0
(Contact Name) �..I a 0 Y-- _P-. N (Phone) a 5 Z -2 O ''D e1,50
(Address) 14A 1 sokot(/-i. S pYio1 ' Lake i /iA/ J
TYPE OF WORK 0 New Construction Nifieck OPorch ORe•Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
['Addition DAlteration ['Utility Connection
CODE: DI.R.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 9- SOo e 0 0
Occupancy Group: ABE F HI MR SU
(excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information • ' ..lication which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
abov- en revlsd property an. all cq action w onform to all existing state and local favus and will proceed in accordance with submitted plans. I am aware that the building
ficial can revoke this permit f. .st c e Fu. ore,I hereby agree that the city official or al designee may enter upon the property to perform needed inspections.
iilli G7 %'202 11I1I
" Signature Contractor's License No. Date
Permit Valuation3 Ochs • 00 Park Support Fee # $
Permit Fee $ 88 .ZS-- SAC # $
Plan Check Fee $ S7 3 Water Meter Size 5/8"; 1"; $
State Surcharge $ j . 50 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 $ 1y?. I
/
This pplica 'on B I es our Building Permit When Approved Paid Receipt No. G p x'1,
/ ' /_ Date By O!j !y/
Bui ding Pial ate
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 Prior Lake,MN 55372