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F PR/0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A.O. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
7...). x
AND UTILITY CONNECTION PERMIT
'f• Zo. / S
*IH Oil' n I.white File
nes 2pink City
PERMIT NO.
.
3 Yellow Applicant /�
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1 CI1 ��lbn' V-}— 6rc --b S E R i
•
LEGAL DESCRIPTION(office use only) ,
LOT J ( BLOCK / ADDITION�4K� /Q� t 4 I..."..45f',4 da /V PID ab'0g3' &9 c
OWNER �y� 00CiLJ)"' -\0- �1 `�I 1
(Name) ►"_"'� � � �� (Phone)
(Address) i'1 1 fvliklo-v\--\GJ�� 6 cc,1— Se-
BUILDER GBUILDER 114U-, (A)1 h clAQ S--t\ re,. (Phone) Lin-S/11- S I
(Company Name) Lit-)-- (�,
(Contact Name) 1'e S tt en (Phone)nLi«' S'1 " ( If
I
(Address)9-'-4 fi�� J Let/IA--5
S4 yu J u v 1 i t
TYPE OF WORK 0 New Construction ❑Deck EPorch ❑Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
['Addition DAlteration ❑Utility Connection Ii‘iV\)
i'llCODE: ❑I.R.C. ❑I.B.C. tsc.
Type of Construction: I II III IV V A 13 PROJECT COST/VALUE S L ?(TO`
Occupancy Group: A B E F HI MR SU (excluding land)
Division: 1 2 3 4 5 1
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 prope anthat 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 is p'mit f r just cause. Furth,- ore, �reb e that the city official or a designee may enter upon the property to perform needed spectwns.,
X (/ �cI771,q0� 1 'I c�i i D
a► Sig ature / i Contractor's License No. • ua
Permit Valuationt • Park Support Fee # $
Permit Fee $ '"4 y 1 Si SAC • # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
a) Pressure Reducer $
State Surcharge $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $ 47
Gas Fireplace Permit Fee $ TOTAL DUE $ 'f S, /K
This Application Becomes Your Building Permit When Approved Pais '1,1 Receipt No.
ansa
Date ----
1 .7_ o . \c 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. 1
I
I
• Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
CI 5-. 15