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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
.. AN1 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ff / //
AND UTILITY CONNECTION PERMIT (P r 1, • 1rr7
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1.white ie PERMIT N
2. Perak City O. ‘44_-
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-613
3. Yellow Applicant `
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1601/ 5eNyler PI gl5e ltivd , 1)(;°( Lok? 41W 55377
LEGAL DESCRIPTION(office use only)
LOT q BLOCK 3 /241 iti5-k- 4, A Ickft, PID L' 40-08-0
OWNER
i
(Name) raVi$ Wordrinw+ '1S2-221—if(36
c t (Phone)
(Address) 14 LI Ie te»1r''lttr ;UricZ4 Aid 1 ,Pt4i( eMN 45371
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction IELDeck ❑Porch ORe-Roofing ❑Re-Siding OLower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
CODE: tom' .R.C. I.B.C.
0 Misc:
Type of t nstruction: I II III IV V AB
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ gI QpO• uo
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 thisLLue--rt--rait for' carthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation S-°00. a Park Support Fee ## $
Permit Fee $ SAC ## $
ftp •-75
Plan Check Fee $ 7 , c---F
F Water Meter Size 5/8"; 1"; $
State Surcharge $ z Co 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 DUES 6_/O,i4— $ ( 9 6.17
This Applic, i), :/omes Your Building Permit n Ap. t ved Paid /61(?'• 1 f Receipt No. //5 l 7
. 41.4L
�� - r d I k
_ Date 6 .// . 1BY
Ai lu
Buildi :0 .— Date ,
This is to certify that . req -s in the above application and accompanying docu nts is in- cordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the. Pl.'f const tes�a temporary Certificate of Zoning co 'fiance. d allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. �� A A a /0 fi-
r r-
Pl: rain_ +hecto –.0*--" Dae Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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