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FPIO4; 'CITY OF PRIOR LAKE BUILDING PERMIT, ate Recd
. A.0.
T 14b ORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT C4)Z/, IS
*1
14NES011' I. White File /5T
/ / r�z. Pink ciry PERMIT NO. /I/`/J'V
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
°2 (.( Fix 161, ITvi MO g
LEGAL DJOCK
Z
CRIPTIONO (office use only) / �� z--c/...5-
LOT 2—ADDITION CA/e v s 6 1 PID 5_51/2//
2 w0 .2/
OWNER `
(Name) beby-c.., L
ei v. (Phone) —7 G3 -- 200 2?/ 7
(Address) 'L J( leAjTki 13 apt/ Let kp 111,U -31z-
1
Z
1 BUILDER �/ / / r
(Company Name) c 0 i C CV 4 4t"1"1 C—l.-C (Phone) 6 SI Z i [1'75—
(Contact Name) , ,�. , .\-'(cA.-e / (Phone) FOVII E—
(Address)
(Address) -7 3 00 I4L&dS U,'1 gtv A./ Sot 200 dla./ &Qt MA c-
--i ZO
TYPE OF WORK ❑New Construction ElDeck ❑Porch Re-Roofing ORe-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. El Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 1 i /1/4/, 3
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 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-mentioned property:n. t at all construction 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 revoke thi .`mi,o just cause Furthermore,I hereby agree that the city official a designee may enter upon the property to perform needed inspections.
r
X 4/ C 63 %,t) 1/2i /1c
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ / SAC # $
Plan Check Fee $ V\L) Water Meter Size 5/8"; 1"; $
State Surcharge - $ , e Pressure Reducer $
Penalty $ ! ip ewer/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 /1
/ � 1
`
This Application Becomes Your Building Permit When Approved Paid f\6 , ) Receipt No. 2_ CS-
Date <V.\
By
CA 4
Building Official Date c, y
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