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CPRlp�P CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / 13
AND UTILITY CONNECTION PERMITl . Ir
t�
HeSot�'Illk
i White File PERMIT NO./5 / g
2. Pink City / , e,
3 Yellow Applicant
ase type or print and sign at bottom)
DRESS ZONING(office use)
37_ 20 LA- �_ L v � i t N6,0 its
LEGAL DESCRIPTION(office use only) ` ZA
LOTS 1 BLOCK l ADDITION /1/0/46 3 '# TZ 7� D 25-371---‘)37-0
OWNER b`--,„4
(Name) (Phone)
(Address) S�4-y 7
BUILDER CompanyName) / ��C��'L[/./C e (Phone) 4/2 2S 9.1/47
(Contact Name) s� , (Phone)
(Address) Z Q90 / ,vi1./ 0/ —
. 16/�
TYPE OF WORK 0 New Construction ❑Deck ❑Porch �[Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition ❑Alteration DUtility Conne tion
CODE: ❑I.R.C.41 ❑I.B.C. El Misc.
e of Construction: I II III IV V A B PROJECT COST/VALUE $
pancy Group: A B I M R S U (excluding land)
•
isiion: 1 3 4 5
I hereby certify • hal/ irnish=. formation on th.application which is to the best of my knowledge true and correct. I also certify that l am the owner or authorized agent for the
above-mens c . .rope[a and tI 4t al construction ill conform to all existing state and local laws and will proceed in accordance with submitted plans. I am a are that he building
official c• e this p mit f. just.ause Flirt. -more,I hereby agree that the city official or a designee may enter upon the pro e yto perform needed insp�ctii s.
Signature Contractor's License No. Date
Pe ." Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ ICWater Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ U " 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 $
///J
5-4° ,-5.....-
This Application Becomes Your Building Permit When Approved Paic'j ± Receipt No. 33 9 7
Date// / /3 . /c By S
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
1111,1
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
ied
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372