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CPRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT"
L White File uz
NES�S� 2. Pink city PERMIT NO. l
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
4"5J 1 r'ier 0,v, S '1
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID ZS—4tr- -et', 7-0
OWNER e r ce (1.1.,,A '1°Y) (Phone) 61 2.--1?-- - 6690
V y /
(Address) 3 �"�/ //f-et� a,„,..... cw
(CBomp nyy Name) OilILDER ' '>t(Oefs (Phone) G 12-2.20— 2-(O6 1
(Contact Name) 1;1:2 2/r4-h. (Phone)
(Address) 12,9 2- 4,:-Fe,/ �>- !V8 4 fpr�' j v - MA/1 S'-O 9-
TYPE OF WORK ❑New Construction Keck ❑Porch DRe-Roofing ORe-Siding ❑Lower Level Finish ❑Fireplace
DAddition DAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc. U
Type of Construction: I II HI IV V A B PROJECT COST/VALUE $ !/ /A<
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5 l
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 revoke this permit for just cause. Furthermore,I hereby agree that e city official or a designee may enter upon the property to perform needed inspections.
X r5fitP 3?-3 0 Sr c16/42
-!r Signatu%-
! Contractor's License No. Date
Permit Valuation Lf;c0 C30 Park Support Fee # $
Permit Fee $ �� 703. mv SAC # $
Plan Check Fee $ 4,4 . 9C Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
acvc"
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 $ PI
f I(, c75
This Application Becomes Your Building Permit When Approved Paid 1, Receipt No. /
711
Date .. 17(o7/� By /YOU
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
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Mirirlesota DOLI
Online Electrical Permit System
for Homeowners
ww.doli.state.mn.us/CCLD/
etrakit homeowner.asp `
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