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CITY OF PRIOR LAKE BUILDING PERMIT,
Date Recd
YRIO RARY CERTIFICATE OF ZONING COMPLIANCE 3 O. (S
F o R; TEMPO AND UTILITY CONNECTION PERMIT
s,�
7...., en
I. White File PERMIT N
2. Pink City
�, 3 Yellow Applicant
��NNES�� ZONING office use)
c
(Please ,e or ,tint and si: at bottom)
ADDRESS r
-
LEGAL DESCRIPTION(office use only) PID
LOT BLOCK ADDITION
6 " yG 'Z
�,� ,� (Phone) �S'� Y 3 �
OWNER .� �� �
(Name)
(Address) S c*�^—� _
(Phone) /� 7
BUILDER 4 .
(Company Name) �� (Phone)
.�(Phone)(Contact Name) �� / f u
(Address) Lower Level Finish ❑Fireplace
New Construction ❑Deck ❑Porch 11�'e-Roofing ❑Re-Siding ❑
TYPE OF WORK 0 Alteration ❑Utility Conn: tion
❑Addition ❑ D Misc.
I R.C. DI.B.C. B PROJECT COST/VALUE $ ___7_?--g--4?-----
Occupancy
CODE: ❑ • I II III IV V A U
Type of Construction: E F H I M R S (excluding land)
Occupancy Group: A B l 2 3 4 5
Division: knowledge true and correct. I also certify that I am the owner ur authorized warthat
agent for the
lication which is to the best of my to perform needed inspections.
i that 1 have furnished information un this app a designee may enter upon the property /
rt will conform to all existing state and loci laws aged will proceed in accordance with submitted plans. tam aware that the building
1 hereby ce ty official 'f p ��
abovial can ned property and that all construction agree that the city �
official can revoke t :permit for just cause Fort ermore,I hereby g — Da
I '� Contractors License No
X Signature #
Park Support Fee
IINIIIIIIIINNI
Permit Valuation IIIIIIIIIIIIIIII
Permit Fee 11/11111111111111111 111111111111111111
Plan Check Fee MggaillNIIIIIIIIIIIIININIII Pressure Reducer
Sewer/Water Connection Fee #
Penalty will.111111111111111111111111
Water Tower Fee
Plumbing Permit Fee Builder's Deposit
Mechanical Permit Fee Other 111101C4111111Sewer Water Permit Fee TOTAL DUE
Gas Fireplace
eplace Permit Fee Q�ei.t No. ���—
Permit When Approved Paid �
This Application Becomes Your Building Date �
•
Date
Building Officialproceed as requested. This document
st when
Zoning Ordinance and may 7 Certificate of Occupancy
that the Plannerreanconstitutesn the above application
emp iaty and accompanyingtoZoning documents ise in andcallows accordance sttuh do City b
This is to certify
Certificate of compliance allows construction to commence. Before occupancy,.
when signed by the City a temporary
issued. Special Conditions,if any
Date
Planning Director447-9850
24 hour notice for all inspections(952)MN 55372
4646 Dakota Street Prior Lake,