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toCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
t. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
fti AND UTILITY CONNECTION PERMIT g . i4 ES
...., �° I. White File pERMIT NO. _
3 Pink
city 5
2 YellowiApplicant `
(Please type or print and sign at bottom)
,^ ADDRESS
` '31 6 �� �� ZONING(office use)
5ervur - �
/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)
C 4IAC K p o-i-uP (Phone)
(Address)
BUILDER //''' (79) q-(Company Name) \/ Coiv--FruiQi, (Phone) 1 ? - 7?l 7-' 74
(Contact Name) Y1 (55 ri CK SO/9
(Phone)
(Address) ) DO 1 C4 5i 5 /71f ri /f .1 MAI t A 57'/I
TYPE OF WORK G New Construction Deck DPorch GRe-Roofing GRe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition GAlteration ❑Utility Connection �j
CODE: I.R.C. DI.B.C. ( Misc Re -`Ge .J ecK ()off W l ;e( l°,
Type of Construction: I II III IV V A B ,\ felt n /'�
Occupancy Group: A B E F H I M R SU PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
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 and that 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 this permit for ust c tutu.ermore,I hereby agree that the city official o a d°signee enter on th property to perform needed inspections
g/fizitesyy
Signature Contractor's License No. Date
Permit Valuation 5-(30 Park Support Fee # $
Permit Fee $ 72-5 r SAC # $
Plan Check Fee $ \ to t Z>c 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.. ) e-Tc-
e
This Appl ion :e omes Your Building Permit When App ved Paid 4-1 6t' Rec No. 46-50
iir 411, •AL b Z Date � Z r BY
;'l r- ."t Dat f 7
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