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F Pitio CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
a TEMPORARYAND CERTIFICATEUTILITYCONNECTION OF ZO0NING COMPLIANCE
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*I'VtVESOl
�, I. White File
2. Pink City S`PERMIT NO. / eeo
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
17i 4 SvNizC ,k' etVC.0 s-
LEGAL DESCRIPTION(office use only)
LOT 7 BLOCK / ADDITION c..iGL^D 111 1,74) f-i-r-Mew PID Z- )e'caale,
OWNER,..-, ,� G"'"Pfc." (Phone) 6O/2.-57,5 - "ts�
(Name) 7 IR.C�✓N t /L."V'f'S0._, �G�G� 1✓
(Address) i sAe4it`
BUILDER //' ,--t. ". ..C.,
-��Q�
(Company Name) �4-'iDOLAA LOAD S ".VerrWA) (Phone) ? Z '-�3
(Contact Name) /G ^:e <( (Phone) 6et°`''lr *--
(Address) Z S 1/� 3 2 / L-S- j
Ll.GY.t,.c.�(1vt> /t S���i-�CSsL ^Z 9 2 -6 3 7 3
TYPE OF WORK 0 New Construction ['Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
❑misc. / `tr_.ba) 1470LIA—C
CODE: ❑I.R.C. ❑I.B.C.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ /7.5
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished-info . +- • is 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
aboye=rneiiiione. pro. .i that all co - tiot ill :":; to a,existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
o i cial can v /' is per ust c e` F �;r, eby a; -e that the city official or designee may Pon the property to perform needed ins ections.
X / • r', S 3 Date/
Signature Contractor's License No.
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 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 $ '!- " 4'
This Application Becomes Your Building Permit When Approved Paid I '75----- Receipt 2.4-0,1
Date 3 ./S' By _
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