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o0t.f PR/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 7✓ �/
AND UTILITY CONNECTION PERMIT
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44N.set P. I. White File PERMIT NO. /4-
3 Pink City
3 Yellow Applicant
i•• t i Tint and sign at bottom)
1 • DDRESS
-- 3, � �t' aZONING(office use)
//5- G�� 2, . 6-'c--1
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER / / Q�^ 1
Name ��n L A7 / p 1 (Phone) 2S f ' 2/7"- C)/0
(Address)
BUILDER - e) /r
d'1 cs o '.�,9 ))
.c •••.. . G- / e---,
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y ontact N P('-,,ir /1::::t,/ ' one)
7:dress dC.., ., Z7-.....-,04, r" PZ ',->t' C6b- _C1701,'
TYPE OF WORK E New Construction ❑Deck ❑Porch IR1Re-Roofing ❑Re-Siding ['Lower Level Finish El Fireplace
❑Addition ❑Alteration ['Utility Conne ton
CODE: ❑I.R.C.,11
❑I.B.C. Ci Misc.
e of Construction: I II III IV V A B
pancy Group: ABE F HI MR SU PROJECT COST/VALUE $
vision: 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
official can revoke this permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
ignature�} `�
C e�y" Contractor's License No. D - �•- 5r,.5r,. /#1
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 7f- 10 ei
'�� eipt No. lj 76k
Date 7 i,/1- '
Building Official Date /
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
n 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
.sued.
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