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CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. AND UTILITY CONNECTION PERMIT
4- • i , i(„p
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��NNESD�P I. White File PERMIT NO. I�w
2. Pink City (6 `z
3 Yellow Applicant •�'
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
S S37 /ill Ovent 6,41-v51(.4 S
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNERc't-6j S-4 I -1-e,
(Name) �
11�� tt (Phone)
(Address),
S(e, "101- ry 4 C r've D 1 Vee+ S'
BUILDER II� 4 ( j
(Company Name) K-''//-�1J ��S TCtn J'� e. ) L-L C (Phone) g 5�— 9S 7— 451
(Contact Name) 1'c.d y )A6'- S (Phone)
(Address) 'Zc q Z S t3 ,..,�.,y, Ave
TYPE OF WORK ❑New Construction ®,Deck ❑Porch ['Re-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
['Addition ['Alteration EUtility Connection
CODE: [ eR.C. ❑I.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ I 1 50
Occupancy Group: ABE F HI MR SU
)
Division: 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 /c — --L___---- 66-6.A5337 y-/- zo jc
SignatureContractor's License No. Date
�vU 'Lr�
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ ra Water Meter Size 5/8"; 1"; $
State Surcharge $ 7 .c)). -"1".- 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 • q&
(p(0
This Appl �,tis Becomes Your Building Permit Wh Ap roved Paid t
J Paid tit _7 9 lecei t No. 417,�
/I Date f� CZ_ CO By atZ
?mom .rml ate
This is to certify that the req est in the above application and accompanying docume s is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when si n f�y the City Planner constitutes a temporary Certificate of Zoning comp ance d allows construction to commence. Before occupancy,a Certificate of Occupancy must be
Issued
tt Oink 4—. CA3
ector Dat- Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
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