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of PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE b Z
AND UTILITY CONNECTION PERMIT 3
~�NNFso:c I. White File
2. Pink CityPERMIT NO. /3_ LJ
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3 Yellow Applicant
se
type or print and sign at bottom)
DDRESS
3 L So /l j��/(L (/ -) / A— ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PIDZS , /32, 054 . 3
OWNE •---
(Name) 36 n M`\)" (Phone)
(Address)
I
BUILDER ,I�� r
(Company Name) , . O 5 4 0 I U4\ (Phone) q S0 -o& SC:
(Contact Name)' CF1c\y\ �E'e Aco ( — (Phone)
(Address) )((1&(' ca ` ►k/ _ sE ?irk: r Lei«_ V'VJ S S3 7d
TYPE OF WORK 0 New Construction DDeck ['Porch Xe-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
DAddition DAlteration ❑Utility Conne
CODE: 0111.C. ❑LB.C• 0 Misc.
e of Constructilipcii
on: I II III IV V A B PROJECT COST/VALUE $
panty Group: ABE F HI MR SU (excluding land)
ivision: 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 prope , d that all ruction will conform - ', - g state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can r •r ausc. Furth ereby agree that the city official or a designee may enter upon the property to perform needed inspections.
1O —a(( H3
Signature Contractor's License No. Date
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 I $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid - 1
��7Re pt No. le)_..< Z 1--
Date /0 , 2- 4 ( 7 6"-- -
Buildin Of ficial Dates 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
en 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