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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
N 1 TEMPORARYAND CERTIFICATE
UTILITY OF ZONINGCONNECTIONPERMIT COMPLIANCE I 4.. 0?
r`V N E S o�
I.White File PERMIT NO.
3. PeCity 1/'�• o/�v 03
3.Yellow Applicant (�
(Please type or print and sign at bottom)
ADDRESS rEf F T_-S PO f•-)(J
ZONING(office use)
1 15 0 0 Zig t r 5 'RS S 74\ti i--..-AFG-Knkrpirey
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
It
(Name) 5SL 7/ I (Phone) S5 " `Z.'2 6. 00 0 a
(Address) `V S 4‘)a 'Tu v.•e.eae; ./" Rad L4c ) t,, ,,,°t°, .::.; .` c
BUILDER \ , `�
(Company Name) ti e Y`c r 4 tt(- - y o,yn K�t v^ lin g p (Phone) 6 1'" 7- SS1®
(Contact Name) .Tt VU tom.! t 1 �1 Va rN S a`.. (Phone) 1r ' 4/:-'411' t"1
ft.t
(Address) I¶`t.t Butvid4,.. Q (,)14,4rr, te.14r,.. l+4i<t1} ig,‘ S t le
TYPE OF WORK ❑New Construction ODeck ❑Porch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
['Addition Alteration ❑Utility Connection�cyp,�q�2.-est..-\S‘c&o-�- \\g )ç p '` Z� ° �Q-48e5.
CODE: ❑I.R.C. ❑I.B.C. 0 Misc: vo5 )t I Sr:A t r t✓`s V\
;CAN tH \''‘oo&
Type of Construction: I II III IV V A B 1'4°4).G
Occupancy Group: A BS; F HI M R SU PROJECT COST/VALUE $
Division: 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
offici�kpan revoke this pe t rjust cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
`Yt GaoZ, l'a- Z2.-0aN
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 5 A_.z5 SAC l# $
Plan Check Fee $ 2 T54.2.k. Water Meter Size 5/8"; 1"; $
State Surcharge $ t 70 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 Fir-.lace Permit Fee $ TOTAL DUE $ C/O. 2-
n Be� v�Les Your Building Permit When Approved Paid q Q. Z( RecP t No. ,s' 33f
4
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' Date L. . S. LD /
1 (�
Bu',ng Official Date igle
This is to certify that the request in the above application and accompanying documents is in a ordance 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,Ilow construction to commence. Before occupancy,a C rtificate of Occupancy must be
issued.
tot i kf `� l04. lj /°' Or hs ilk t. t
Planning Director Date Special Conditions,if any i
24 hour notice for all inspection (952)447-9851 fax(952)447-4245
4646 Dakota Street S.E.,P . Lake,y'l'esota 55372
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