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0 0,� CITY OF PRIOR LAKE BUILDING PERMIT,
�+ TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
en AND UTILITY CONNECTION PERMIT
44piEsolP
I. White File I PERMIT NO. 1 D 4 4 7
2. Pink City I!
(Please type or print and sign at bottom) 3 Yellow Applicant `
S
ADDRE
J(LJ4 5 -' n-0 .r_, 5-1-.
irs ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT '*� Lerr'I" TIO _> /�,�
PID c �'.. q„2 W/
OWNER
(Name) 'Prl‘Y,...-e_ V O In �(X
(Phone)(0I D-996 9'i3S'
(Address)
BUILDER
(Company Name) PX,C (phone)S(6 CA..N— lq t5(—d to�7
(Contact Name) GJ �QQ
(Address) 19�p a t tt (Phone) O
C!�.�i G W-e--S4 1 ose..knl ltc m N3 SS 113
TYPE OF WORK D New Construction DDeck ❑Porch I
❑Alteration ❑Re-Roofing ❑Re-Siding DLower Level Finish ❑Fireplace
DAddition ❑Utility Connection
CODE: DLR.C. DLB.C.
❑Misc.
Type of Construction: I II III IV V A B f I o pp
Occupancy Group: ABE F HI MR SU
PROJECT COST/VALUE $ // /S
Division: 1 2 3 4 5 (excluding land)
1
I hereby certify that I have htrnished 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-mentro ed property and that onstruction 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 oke this permit for t c Ise. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed'lisp•ctions.
X n A 1> G i 3
b09 S3 025 (i)LS—
Signature Contractor's License No.
ate
Permit Valuation Park Support Fee #
Permit Fee $
$ SAC # $
tiM)5
Plan Check Fee $ 4 Water Meter Size 5/8"; 1";
State Surcharge $ $
Pressure Reducer $
z:50:0)
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 $ 7cr
TOTAL DUE $
This Application Becomes Your Building Permit When Approved I PW /7 q • 7—C
Yrr
a ( c I Receipt No. /2 .5�
til
Date By
Building Official Date s: ..
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
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 Special Conditions,if any
4646 Dakota Street Prior Lake,MN 55372