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eiOt;PR1CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE C AND UTILITY CONNECTION PERMIT
NESol� I. white FilePERMIT NO. �� �¢5'?. Pink City
3 Yellnw Applicant type or print and sign at bottom)
ADDRESS
ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) 1!d r J e3 Q- (Phone)
)
(Address) �aSP�J tit-tell _ S , gaOtotet 7/
BUILDERXS
(Company Name) CC Chis .6(4-//o4-YS 5 MA"(Phone) 956.1--a i S—.S/"
(Contact Name) `e ✓`'' )'b c i s
l /�t:ue-t_. L� "one)
(Address) �C� r
,�Gc rnsvi i111?�
TYPE OF WORK 0 New Construction ODeck ❑Porch e-Roofing ORe-Siding DAlteration g ❑Lower Level Finish ❑Fireplace
❑Utility Conne tion
DE: DI.R.C. ❑LB.C. 0 Misc.
e of Construction: I H III IV V A B
panty Group: ABE F HI MR SU PROJECT COST/VALUE $
41ivision: 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 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
1 official can permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
� X 4'17933 i4-u 6., P-CP!3
Signa re Contractor's License No.
Date
Permit Valuation Park Support Fee ## $
Permit Fee $ SAC ## $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
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 f $ TOTAL DUE $ '7 75.-
This Application Becomes Your Building Permit When Approved Paid �- /5'
! is 7
Re pt Na 6, (��
Date S/-,Co.,/f B .
Building Official Date
0 is is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may
en signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,proceed as requested. This document
issued p cy,a Certificate of Occupancy must be
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