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of P_ CITY OF PRIOR LAKE BUILDING PERMIT, Dale Rec'd
y TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 7 ( c
��HNESo�� I. white File ty PERMIT NO. /5
^l�'
3 Pink
3 ApplicantYellowiqc G%
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1� ' -i Deet /� Dr. kc7�
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID 9. 11C0. 62-1-2P
OWNER
(Name) t5 s C�� (Phone) ° 5 2, — Cr�
.00 '"-1 9
(Address) i 9 I -7 ae e r -gl e ( c-i- D r,
BUILDER
(Company Name) 50 I�r (� .�-�t 5 _—et L _S 1 b'
�+ i (Phone) b� S S� Z
(Contact Name) 5f o� V-t I�e^ c," (Phone) -76,S - 5-5'7 - 57 Ct Z-
(Address)
(Address) SO 0/ r e.,--, .4-r/a- N,
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ['Alteration ❑Utility Connection pp
CODE: DLR.C. DLB.C. El Misc. sot^lim
uoe
Type of Construction: I H III IV V AB / 5-00 , 00
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
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 and that 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 r yoke his permi fojust cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed snap•cttons.
Signature Contractor's License No. Date
Permit Valuation `may' rt-^ Park Support Fee # $
Permit Fee $ /3 --' SAC # $
Plan Check Fee $ 14 1-434
Water Meter Size 5/8"; 1"; $
State Surcharge $ 00 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
PIumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
1v
This Ap lication Becomes Your Building Permit When Approved Paid ( 2`2:(p7 Receipt No. I i
6 r
Date By 504,4_-J
rc/'7/1C
Building Official D to
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 du_ument
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy inust be
issued,
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372