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0 o. CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
c . TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
m AND UTILITY CONNECTION PERMIT 417,1Z-'��
;torNSSu'iP
I. white Cit I
PERMIT NO.
2. tint: City ko, 303
type or print and sign at bottom) Yellow Applicant
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RMIT N�/��
S 3 S Y V l i h I I C i r C(5-E ev o v- 'W (/)a Ice A/S53, ZONING(office use)
LEGAL DESCRIPTION(office use only) "
LOT BLOCK ADDITION
PID
OWNE
ia
((Name) D u SOC (Phone) G9 I a U 5 - / d
(Address) (508 V1/11-1-0(U-1 1 a UC LC S E ( v-tLv- (Li V/v 53 fl
BUILDER o
(Company Name) j GVU.,V\ e X V I o r s
Il (Phone) Cco ) 2t/ - /Li b
(Contact Name)
SS (Phone) ( � Cti �j
(Address) (-19i):120 � (�U�
o blur Lun L mL CEnccs, MAJ 5f//Z)
TYPE OF WORK •' New Construction ['Deck ❑Porch ORe-Roofing r Re-Siding ['Lower Level Finish 0 Fireplace
DIJtility Connection
CODE: DI.R.C. ❑I.B.C. DAlterat 0 Misc.
e of Construction: I II III IV V AB coo .
lilliu
panty Group: ❑Addition ABE F HI MR SU PROJECT COST/VALUE $
vision: 1 2 3 4 5 (excluding land) I
I
I hereby certify that I have famished 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 mayenter
g upon the property to perform needed uispcctions.
X 3C_� - ov lii c .
Signature / Contractor's License No. a e
Dace
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
I $
I
Gas Fireplace Permit Fee $ TOTAL DUE /04,
4 `D
This Application Becomes Your Building Permit When Approved I Paid 7(3
Receat No.
Date 4--_l7,-,(,"
ski / I
Building Official Date
to certify t icon d mrnce wth hZoning dcmroas edm
signed by thethat Citythe Plannerrequesconstitutesintheabove a teapplmporaryatiCeanrtificateaccoofpanying Zoning compdocumentslianceis andinaccoallowsdaconstruction
te toCity commenceOrBeforeinane occupancy,andaypaceed Certs icaterequof Occupancyste . Thisdocumust ent be
ucd.
Planning Director Date
24 hour notice for all inspections(952)447-9850 Special Conditions,if any
4646 Dakota Street Prior Lake,MN 55372