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r). CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
AND UTILITY CONNECTION PERMIT `l.. 3 6 '07
.... „,„ , ..,„„„,, ,
4-it'NES oq P
1. White File I PERMIT NO. I
2. Pink City r�, �+`�
(Please type or print and sign at bottom) 3 Yellow Applicant v /G/J((J/�
ADDRESS
5it �� �� ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name) B YO n 1e. -,P�� e_ O V e rG..s p -
�y _ '` (Phone) l� ` �'4� / �57
(Address) 5 1q 1 g ( c a 4 5:c 5-E %I"'t 6 'r . I'A NI , 55372_
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ❑Deck ❑Porch
EIRe-Roofin Re-Siding ['Lower Level Finish fireplace
['Addition EAlteration ['Utility Connection ,p� /�
CODE: 011.C. ❑I.B.C. Misc. yV IN,(/o ws
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MRS PROJECT COST/VALUE
Division: 1 2 3 4 5 `excluding land
I hereby c- ify 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- f oned property and that 41 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 is revoke this permit for) se Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
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
This Application Becomes Your Building Permit When Approved
Paid 74,, eft) R ipt No. .57Z.....5.3
Date it3o,(U B
Building Official Date
This 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
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.
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