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CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
(4PRi
, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT ' Z I. I
41.4'NEsol� I. White File PERMIT NO. `
2 Pink City i 4 (�.c'�1
3 Yellow Applicant
t � 1"
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
'Z 9°Z 1 (oA A' 15.E
LEGAL DESCRIPTION(office use only)
LOT I BLOCK 1 ADDITION k/ZCLC 49 4..)112 ,4,1I , PID a•-• 953. (g1-7
OWNER
(Name) /f4/'f i°5-" Z (Phone)
(Address) Z 9 Zl COv o i. "Arht
l BUILDER
(Company Name) -Cil 771 irre ..v/rv,-,16roofs-#ti6 /"'C_ (Phone) 6/2-94"69/
(Contact Name)4p444 Lt/.,wff/Y4 (Phone) 6/ - -)/6 — 69/6
(Address) /3i ?r.•, ' ^7 an. cf 4fi0/'ff X10,-cl SS.3-
TYPE OF WORK ❑New Construction ►!+ii eck ❑Porch ORe-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Altera .n ❑Utility Connection
CODE: R.C. ❑I.B.C. 31 )�
` . ❑Misc.
Type of Construction: I II III IV V A B
PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land) --N__________
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 . opc a.• hat a _ truction w conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
I official can revo t r' , --it for sc Fit ore -reby agree that the city official a designee may enter upon the property to perform needed ins rtions.
I x %/ e-1*6Ze//Z S z/ ,
.ie Contractor's License No. aPl to
Permit Valuation - 5-boo - Park Support Fee # $
Permit Fee $ 01-1-1 SAC # $
Plan Check Fee $ 1 c,f Water Meter Size 5/8"; I"; $
State Surcharge $ 2..co 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 I $ TOTAL DUE $ tel
to.
This App rad Becomes Your Building Permit Wh Appr ved Paid Receipt No./�-7_(40r—I
i /t�( / Date L �' By E J
l . l�ii _ ZZ 1
r Bt tiding Official Date
This is to certt- hat th request in the above application and accompanying docum•nts is in cordance with the City Zoning Ordinance and may proceed as requested. This document
when sign. e e1 Planer constitutes a temporary Certificate of Zoning co .fiance d allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued
A 2`_ 5 Z 1'
' Planning wee.r 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
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