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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
of.
FPRlp
Ar
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE G e /1-
AND UTILITY CONNECTION PERMIT
U !L7
44NE90iP
t. White File
2. Pink City I PERMIT NO. /
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS
17\g0 SunraC'irc.teS 'Pr'\OAr ‘CAO 65 2
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER,—am \aYCk 7* C e, S (Phone) lY \a a q S -1(€
(Address)
BUILDER (Phone)
(Company Name)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ❑Deck OPorch i Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ❑Alteration ['Utility
❑Misc.
CODE: DI.R.C. DI.B.C.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
ct. I also certify
hat I
the
or
zed agent for the
above-men one hat I have
and tlhed information on all construction will onformhis on which is to to all existing statee and loest of ctal laws and will proceed iny knowledge true and accordance with isubmitted eplan owner
It am awaretthat the building
offici ca revo a this permit fo jt.t cat`e Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections
X • Contractor's License No. Date
Signa e
Permit Valuation
Park Support Fee # $
Permit Fee $ SAC # $$
Plan Check Fee $ Water Meter Size 5/8"; 1";
State Surcharge
$ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
$ Water Tower Fee # $
Plumbing Permit Fee $
Mechanical Permit Fee • $ Builder's Deposit
Sewer&Water Permit Fee $ Other $ Gj
Gas Fireplace Permit Fee $ TOTAL DUE $ ! 75"
,�9�- LS Re rpt No.
This Application Becomes Your Building Permit When Approved Paid -/
11414-- 1
Date 4 q /57— By
Re
Building Official Date
nt
Thisis to
that
application and
documents accordance
sning requested.
a e tais yst
when signed BY the City Planner constitutes a temporary Certificate Zoning compliance and allows construction tthe ocommence. Before occcupancy, Certificate ofOcctpncmutbe
issued
Planning Director
Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372