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of PR/0_ CITY OF PRIOR LAKE BUILDING PERMIT, �._/
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
fid- Z
m AND UTILITY CONNECTION PERMIT
4401 E Set P.
I. White File
Please ,• i. pint city PERMIT NO. `�
or tint and si: at bottom) 3 Yellow Applicant %'
ADDRESS
ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER i
(Name) >< i. 4 v '
�/ (Phone)
(Address)
... / ' /
IBUILDER
(Company Name) 1
(Contact Name) t.� ' C (Phone)
(Address) /; 0 / (Phone)
•.lu g Lr SA-c 7
TYPE OF WORK
0 New Construction ['Deck DPorch 1 Re-Roofing 012e-Siding ❑Lower Level Finish 0 Fireplace
❑Addition DAlteration ❑Utility Conn- ion
CODE: ❑I.R.C. ❑I.B.C.
Type of Construction: 0 Misc.
Occupancy Group: ABE F III IV V A B
Division: M R S U PROJECT COST/VALUE $
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 roauthorized
Iabove-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 rjust cause Furthermore,I hereby agree that the city official ora designee may enter upon the e agent for the
XP p p rty to perform needed inspections.
Signature -- G J 7 /?1 e)'--. 2 /.
Contractor's License No. /
Permit Valuation Date
111111111111111111 Permit Fee
Park Support Fee #
IIIIIIIIIIIIII
11111111111111111 EINIIIIIIMIN111.11111111111111111
Plan Check Fee 111111111111111111
Water Meter Size 5/8"; 1"; $
Penalty - $
Pressure Reducer $
Sewer/Water Connection Fee # $
Plumbing Permit Fee
Mechanical Permit Fee111111111111111111
Water Tower Fee # $
Sewer&Water Permit Fee Builder's Deposit $
gIIIIIIIIIIIII Other $
Gas Fireplace Permit Fee gIIIIIIIIIIIIIIII
TOTAL DUE $
_...•This Application Becomes Your Building permit When Approved
Paid _ Recei-,t No. _ ,
Date U , ! B "NW/
Butldinti 01 ticial Dale
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may
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 proceed as requested. This document
Planning Director
Date
24 hour notice for all inspections(952)447-9850 Special Conditions,if any
4646 Dakota Street Prior Lake,MN 55372