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of p CITY OF PRIOR LAKE BUILDING PERMIT,
( PR1O
c. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
1.(7) AND UTILITY CONNECTION PERMIT3 3 ( 75
4NrNES01;
I. White File
(Please .e or Z. pink city PERMIT NO. ` �/1i
Tint and si: at bottom) 3 Yellow Applicant
ADDRESS /tJI I �'
lZa 1
r -44 ► 0' " "V s-ri?a.. ZONING[ OfficcUse)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER Ilt 1
(Name) I f\e' AO
(Phone)
(Address) /1 1 •
IBUILDER
(Company Name) 41 is' '_ ..it'
(Contact Name) / ��i (Phone) -77-_,7� .� `7 Ll
(Address) �� c--
(Phone)
TYPE OF WORK
❑New Construction ['Deck ['Porch li!'e-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C.
Type of Construction: 0 Misc.
I II III IV V A B
Occupancy Group: ABE F H I MR SU PROJECT COST/VALUE
$
3 4 g (excluding land)
Division: 1 2
I herebycern thatl •
certify • hirnished information on this applicatio 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 pro. and that all constructit ,will conform ' all existing state and local laws and will proceed in accordance with submitted plans. I am aware that
official can revoke thi .. mit forjust ause Furt .re,I hereb agree that the city official or a designee may enter upon the property to perform needed insp ruons.
the building
/ ( 3 .
Contractor's License No.
IIIII
Permit Valua'on gat`
11.11111111111111 Park Support Fee # $
Permit Fee11.11.11111111
Plan Check Fee $
11111111111111111 Water Meter Size 5/8"; 1"; $
Igilnil
Penalty
Pressure Reducer $
11.11111111111111 Sewer/Water Connection Fee # $
Plumbing Permit Fee
Mechanical Permit Fee Water Tower Fee # $
Sewer&Water Permit Fee Builder's Deposit $
$ Other
Gas Fireplace Permit Fee $
111111111111111111 TOTAL DUE
This Application Becomes Your Building permit When ApprovedMINIMI
,
Paid
Rec j.t No. W
Date f )S '
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
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,
issued proceed,a as requested. Tansmustb document
P� Y,a Certificate of Occupancy must be
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