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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
.1.0°41e TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �4, j
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AND UTILITY CONNECTION PERMIT J
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I. Pinkke Cit 1 5— /-1 /0
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44,,,sdo° 2. City PERMIT NO. ` V d
3 Yellow Applicant
(Please type or"print and sign at bottom)
ADDRESS ZO G(office use)
!G / S1 Cry SSar3r CAr
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LEGAL DESCRIPTION(office use only) PID (35 `s�L (,.004'0
LOT BLOCK ADDITION
OWNER
(Name) h�`:\'
(Phone)
(Address)
BUILDER
(Company ? l?C ) U . S Jvt t. ( ) t2 Name) G.� Phone
(Contact Name) 5. "C•f 4". (-41k % L<r (Phone) 4 2 43 " 14 a
(Address)//03 ti 4jrp 5i#f/IA. pl y f i b
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition DAlteration ❑Utility Connection
CODE: ❑LR.C. ❑LB.C. /n
❑Misc. S//-// IS sigkS I� v
txtk ..
V
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ V J
Occupancy Group: ABE 1F HI MR S U (excluding land)
2 3 4 5
Division: 1
I hereby certify that I have fumishe. . ton on this applica'.• • . is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mention instruction will • orm to all ing state and local laws and will proceed in accordance with submitted plans. am aware that the building
„B-` 'j,,.,, i „- .•0. use. Furtherm. e,I her• :ree that the city official ora designee may enter upon the property to perform nee insp. tons.
�� ,%— ' TG 3107 / �i
P Signature Contractor's License No. Date
Permit Valuation j Park Support Fee # $
Permit Fee $ -7(�' i SAC # $
Plan Check Fee $ � Water Meter Size 5/8"; 1"; $
State Surcharge $ 6 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $ IC
Gas Fireplace Permit Fee $ TOTAL DUE $ 7
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This Application Becomes Your Building Permit When Approved Paid ji ....7s Receipt No. / _1 J
9*
Date /a..2:11"-IC BY 6-p.c.()
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
4646 Dakota Street Prior Lake,MN 55372