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O r r``o p\ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
ti TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ( (
�, AND UTILITY CONNECTION PERM
INTI E S°. IT 1. White File
2. Pink City 5�
3. Yellow AppliPERMIT NO.cant
Please j e or Tint and si y at bottom ZONING(office use)
ADDRESS Pr':v r t—C,/LC.,(44 Ni S S 3
LEGAL DESCRIPTION(office use only)
PID
LOT BLOCK ADDITION �r
OWNER rbo.rcA. 'Gdtc_k (Phone) lSZ,-y--2�j� c)
(Name) �W
(Address) I q 6)Z 1 ti-) t I Dt.s -Q IC,w /0 t^.) e(i 0Y- 1 c C - M it 55 3-7 Z
-� 63 -- 551 -s-7o2
BUILDER S O I G'J' M ,)-W 4 5 4" i rti c. . (Phone)
(Company Name) (phone) �'3 r s S 5--1 t)2
(Contact Name) 5 tea f F 67":( t-r �o r` S
(Address) 128'Z-`'1 -1_,„ c1L,.i s-, ,-- i f'G 11L Y:::.V,/•L, 1.I ►^^.4.411, AA c N N
TYPE OF WORK O New Construction ['Deck ['Porch ORe-Roofing ORe-Siding ['Lower Level Finish O Fireplace
❑Addition DAlteration ❑Utility Connection
T,,.bc, 5K 1,- Ltd t,ns'�Ilc„l;cn
®Misc: .
CODE: DI.R.C. DI.B.C.
Type of Construction: I II III IV V A B
PROJECT COST/VALUE $ 15 3 0
Occupancy Group: A B E F H I M R SU (excluding land)
Division:
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 awarethat the building
official can revoke ' permit for just � /10 cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections
C►
6._
X Contractor's License No. Date
Signature
Park Support Fee # $
Permit Valuation 31 Zv o p• op
Permit Fee $$ 4.„�3`, 7 5 $
7 . 6,1 ,{ . Water Meter Size 5/8"; 1";
Plan Check Fee `1 - $
Pressure Reducer
State Surcharge $ 1. u 6)
$ Sewer/Water Connection Fee #
$
Penalty Water Tower Fee # $
Plumbing Permit Fee $ $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other ' $ /2-Z,Gas Fireplace Permit Fee $
TOTAL DUE
This Ap l ti ation :e '..es Your Building Permit n Ap
roved Paid /Z Z ' +ei.t No. /
Date /3 1
'. A .g./.1.1.1__ 1Da3
:u ding Official
te
documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
This is to signed byfy that the Planner is the above application and accompanying of Zang
a Certificate of Occupancy must be
when the City constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,
issued.
Date Special Conditions,if any
Planning Director
24 hour notice for all inspections(952)447-9850,fax(952)447-424
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372