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PRJ0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,�° ,''" TEMPORARY CERTIFICATE OF ZONING COMPLIANC 3, (0 ,15--
•
1 S
E. 7• ' AND UTILITY CONNECTION PERMIT
��NNESD�P I. White File PERMIT NO. ^ ��\\
3 Pink Cityl /5. 4.4 V
3 Yellow Applicant �✓✓J !!��
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
5 9a0 Cara'iial Ric/9c Tra, /
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER —�- G /2/ 6 6 7 . 0 a :3 0
(Name) p In f'7 Q a c h a M (Phone)
(Address) 5 9 or 0 C o retina / Ri cl 9? c Tr i s
BlU(Company
DER Pella Northland (Phone) 9s*2/3 4f S •G b V;7
(CoName) 15300 25th Ave N. Ste 100 /
(Contact Name) Plymouth,MN 55447 ( ')- d 0 CL
(Address) Lie#BC645090 Ph. 763/745-1400
TYPE OF WORK ❑New Construction •['Deck ['Porch ❑Re-Roofing ORe-Siding ['Lower Level Finish ❑Fireplace
❑Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc. 5 to /" L>l0 LJ CLP 14(.LA /i'76 /4 /X/I 71/47
op/ A /n9S 1 /
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 7 /3 /
Occupancy Group: ABE F HI MR SU ,
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 propertyand that al construction will conform to all existing state and local laws and will proceed ino accordance with submitted plans. I am aware that the building
official can revoke th' per it for'use use. Furthermore,I hereby agree that the cityofficial o designee m ayenteerr upon tthe property to perform needed mspl coons.,
G77 Q 3L/L f/
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
•
Plan Check Fee $ Water Meter Size 5/8"; 1"; $ •
State Surcharge $ • 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 $
This Application Becomes Your Building Permit When Approved • Paid • If. 7s- Re eipt No. $ 02..
Date ,3_ ((),l 5 B
Building Official Date •
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