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0"44 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT (0,5 , 11 l
�:NNESoll" 2 White
City PERMIT NO./j ®66(4b
3 Yellow Applicant
print and sign at bottom)
DRESS) $. / ZONING(office use)
(0( Iknno: I ?-o \ S € jam(
LEGAL DESCRIPTION(office use only)
LOT `'"BLOCK ADDITION � _aorta /J :' ' . L . PID( ,9c' OW ' ocq O
(Tame) -. '� `� �!� 16 i (Phone) J
(Address) ! l�V' V 9m 1-r1 If (nOr 1-41(Ce M
UILDE A
/ fJ �Jany Name) � � /f& -,oki S �'�1 (k (Phone) 6l0 I// —s2 /2
(Contact Name) -f/ 1 ' t-,exi (Phone)
(Address) '7 q r-6,i 4' r Ale' ✓Idie! /"(/(/
TYPE OF WORK Ill New Construction ['Deck Porch Re-Roofing we-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ['Alteration ❑Utility Connection q���' i
CODE: ❑LR.C.4„u
❑LB.C. Misc. r,I�,( tdO �
e of Construction: I II III IV V A B PROJECT COST/VALUE $ / (00
'X
pancy Group: ABE F HI MR SU (excluding land)
isiion: 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 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 this permit for Just cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed rasp• lions.
S r Contractor's License No. I to
Permit Valuation Park Support Fee # $
PermitC L�J�� � �$ � is- SAC # $
Plan Check Feell ` .,� $ , Water Meter Size 5/8"; 1"; $
State Surcharge $ 6- Eo Pressure Reducer $
Penalty $ 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 $ Z291
Z<-
This Application Becomes Your Building Permit When Approved Paid 22—:'( 215 Receipt No. /6,2
Date le . al . (C By G '`'".,'
Building Official Date
is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
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
ted
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