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PR! t. CITY
OF % TEMPORARY OF PRIORCERTIFICATE LAKE OF BUILDINGZONING PERMIT
COMPLIANCE Date Rec'd
AND UTILITYC CONNECTION PERMIT `Z. Z. 14
+40tn
,EsOle. I. White File
2. Pink City PERMIT NO. `S 0
3 Yellow Applicant
ase type or print and sign at bottom)
lik
DRESS l /1l� ZONING(office use)
l/ � /6471-4/A LV
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUILDER y �r
(Company Name) giritAI �,(Phone) — ( '7) A r7��(Contact Name) S'C (Phone)
(Address) i
TYPE O
❑
F WORK 1=1 New Construction ❑Deck ❑Porch ORe-Roofing 170 e-Siding ['Lower Level Finish ❑Fireplace
CODE: ❑I.R.C.
❑LAdditionB.C. ['Alteration ['Utility Connection
4110 pe of Construction: I II III IV V A B PROJECT COST/VALUE $
pancy Group: A B E F H I M R S U (excluding land)
ision: 1 2 3 4 5 ID Misc. WW 'Cir
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. are t• t the building
official ca .this permit for just cause. Furthermore,I hereby agree that the city official or a desi ee may enter upon th propgrty to perform needed inspect ns.
Signature Contractor's License No. D. 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 # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 73-, -2s--
This Application Becomes Your Building Permit When Approved Paid e1 37 IJ ', •-ipt No.
Date b ,, z.,_15--
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
d.
re .
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372