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of Pitio. CITY OF PRIOR LAKE BUILDING PERMIT, v Date Rec'd
0a, TEMPORARY CERTIFICATE-OF ZONING COMPLIANCE
0, AND UTILITY CONNECTION PERMIT .5; /5 f r
. 414'125611. I.White File z. rink City PERMIT PERMIT NO./ 0 f/96
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3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
7)))0 WtO6:0 vi� C) R
LEGAL DESCRIPTION(office use only) /� G
LOT BLOCK ADDITION ,#/ /-& �0 5 ' ,4d PID 25' V.9F-^ & - 7
OWNER ` ,^ ^��^
(Name) 1)i 1 1 Ci �Vl,V1 C.11 ---1( Phone) �` - ZiG, 2 L/O
(Address) W to h•e,ic KhAq Ski P(')vt- L l4(1 fl Y) s7 5-7 2--
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ajDeck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ['Utility Connection
CODE: R.C. ❑I.B.C. 0 Misc.
Type of on on: I II III IV V A B PROJECT COST/VALUE $ ' )1000 0
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 authonzcd 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 c,,revoke this per it for ju cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
• nature C Contractor's License No. Date
Permit Valuation 1;-00 0. Park Support Fee # $
Permit Fee $ i/rit /15. SAC # $
Plan Check Fee $ /R rWater Meter Size 5/8"; 1"; $
State Surcharge $ sa Pressure Reducer $
Penalty $ t 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 $/ alta -7 7
This App •<<do, 'ecomes Yoa-Build_is Permit When : •prov i \ Receipt No. /
' I Dater. !" By 6 lik---b-----
Bui,t Di to
This is to certify th• y eques in the above app)i tion and accompanying documents is in cordance th the City Zoning Ordinance and may proceed as requested. This document
when signed by t .1 11. constitutes a temporary Certificate of Zoning compliance a't allows c st uction to commence. Before occupancy,a Certificate of Occupancy must be
issued. �,
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ic.1 I 1 k s. r ( '
:'ann , a:te Special Conditions,if any
2 our notice for all inspe tions(952)447-9850
464 Dakota Street Prior Lake,MN 55372
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