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of PRto� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
Vi:
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT I 0• ° (��
��~Ne salt' I. While File
2 Pial city PERMIT NO. 1 7
3 Yellow Applicant I
ease type or print and sign at bottom)
ADDRESS ZONING(office use)
J55'S Will a d (Ire to IUw' /4-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PIDa25• /33 -oic
OWNER
(Name) (5 yd i,K�5 (Phone)
(Address) /53-5',- (,✓�yf� 1a2c( C/f c A, /IL,/
BUILDER
(Company Name) /�l/s 2r Ce45klei6d) 12Es/''4Nee( LLC (Phone) A *d 6:94'-2dao
(Contact Name) --e-rt Pe/mil- (Phone) '//l •j/r7 _5-96
(Address) '5 f( J,du sir ( s>s. ' /03 ' ' e f'/4;eN , /�1 A) ei c if'1
TYPE OF WORK 0 New Construction DDeck ❑Porch `We-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
4
CODE: ❑LR.C. ❑LB.C.
0 Misc.
ype of Construction: I II III IV V A B PROJECT COST/VALUE $ s4)
ccupancy Group: A B E F H I M R SU i
ivision: 1 2 3 4 5 (excluding land)
I hereby certify that 1 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 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 i per it just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x ' 1X696?c. /0'7/6—
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ p /' 1 SAC # $
Plan Check Fee $ 6 r-^'( , Water Meter Size 5/8"; 1"; $
State Surcharge $ j 0 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $ 5!
Gas Fireplace Permit Fee $ TOTAL DUE $ '�
This Application Becomes Your Building Permit When ApprovedPaid "75_ / -� Receipt No. C
Date lQ/8(1 C, By
Building Official Date
41
is to certify that the request in the above application and accompanying documents is in accordance Zoning may proceed as requested. T los document
n signed by the CityPlanner constitutes a temporary Certificate of Zoning compliance and allows construction
the toCity commence.Ordinance Before occupancy,and a Certfcate of Occupancy must be
ucd
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake.MN 55372