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ePR 04 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F • TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
NI
x AND UTILITY CONNECTION PERMIT �-�
441rEs0'o' I.White File
2. Pink City PERMIT NO. ii- c2
3 Yellow Appliam t-�
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
I' Z34 rt.".r. IA. ,' (4 ii C•t Ni."/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER S(Name) -� Ce � ribe5I (Phone)
QS . 4'5.4'• 4'' S
(Address)
54141 €
BUILDER L .. ..aa�� G
(Company Name) E:I ' Cd 4 -11•01.t -i h al nye de(Phetie) — CI? 7i 0 OQ/7 of
(Contact Name) c r. ;C I)re ti a I (Phone)
(Address) '-G 7 s H W y 13 Li S*v G �1 a ervN
TYPE OF WORK 0 New Construction ❑Deck ❑Porch Nge-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection ^
CODE: ❑I.R.C. DLB.C. ❑Misc. c. + 0 �-'3�
Type of Construction: I II III IV V A B • �t'.:(.�: ' �17W
Occupancy Group: A B E F H I M R SU
PROJECTKIN
(excluding land)
Division: I 2 3 4 5
1 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 ill 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 ju .ise. Furth ore,I h by a that the city official or a designee may enter upon the property to perform needed tnspechons.
X I C R 6 3g1141.; 51. 2-S(' ) S —
S Contractor's License No. Date
•
Permit Valuation Park Support Fee # $
Permit Fee $ —7/_f SAC # $
Plan Check Fee $ / _ Water Meter Size 5/8"; 1"; $
State Surcharge $ 6° 10 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ 7‹ Builder's Deposit $
Sewer&Water Permit Fee $ � Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
/ � �
This Application Becomes Your Building Permit When Approved Paid 79__;,6,-- Receipt No. _ /� C,
Date ,5—c.--_ —/`-') By I,�L`L(
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 iocument
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
4646 Dakota Street Prior Lake,MN 55372