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CITY OF PRIOR LAKE BUILDING PERMIT, C�
Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT q/ _
���NESO�� I White File 15
PERMIT NO. d
2. pelf Cpl ' „ -
(Please i Yellow Applicant
type or print and si at bottom)
ADDRESS / f�/ /�'
JC;D�� ''/ ` C��`��p��e1�) j''f� ZONING(office use)
,*'1 A LA*
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Pd.(Name) 1e4 y z.tutii1 (Phone) 7S `��`l/� •
e —5CTS c
k� /
(Address) c6 62- h' lT CL2,'1, e4-Po J
�,2i.e.7) , 4,14.E /17l1)
BUILDER
x„._
(Company Name) roll eldA) iee5:106111 L c ,C Lae& (Phone) 9.c[." 47Y7.--,.)2.)7y
(Contact Name) 4/7.60V- k' ' 'M
(Address) (Phone) 6,r��� 1''.1)3 q Ci
TYPE OF WORK ❑New Construction Qeck ❑Porch ['Re-Roofing ❑Re-Siding
❑Addition ❑Alteration g ['Lower Level Finish ❑Fireplace
['Utility Connection
CODE: onC. ❑I.B.C. ❑Misc.
Type of struction: I II III IV V A B
Occupancy Group: ABE F HI M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I furnis r•• )rmation 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 pr.... d s constri ion will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
,X\ official can revoke. i iu lose a hermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
, .
Signature Contractor's License No. Date
Permit ValuationPark Support Fee # $
Permit Fee SAC ## $
Plan Check Fee $ 4 7 ,Cl 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 Ap at? BecomesYour Building Permit en A proved Paid , i'
y- Receipt No. 1,31
Date 1-1-20 J� By
(' tragi
4— 5 ()r
ilia Official Da
This is to ce, fy try, the request in the above application and accompanying docume s is in ac rdance with the City Zoning Ordinance and may proceed as requested. This document
when sig i ,'t' t ity Planner constitutes a temporary Certificate of Zoning comp nce and llows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued /
41- 2ZS /5
l
r
= P - • 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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