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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I White
Pink
Yellov.'
I PERMIT NO. ()6 -q~3i
File
City
Applicant
ct +- ILl /V
ZONING (office use)
313~
\J ef-}c~/fS
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
BLOCK
PID ~S-. oS- 0&
o
OWNER
(Name)
H()/(lW
P I tJ U r c4-e-..
(Phone)
i(?ltJ~ [15'1;
(Address)
BUILDER
(Company Name) vY\ A. vt lZ.) V t{/ CD (lJ Sf GO.J
(Contact Name) I f\ R-K '-} 0 E:.. ~
(Address) \ t '1-- ~- t vE.~ e.
TYPE OF WORK D New Construction DDeck OPorch ORe-Roofing
OAdditlOn OAlteration o Utility ConneCllon
ORe-Siding OLower Level Fimsh 0 Fireplace
(Phone)
(Phone)
CODE: ~.R.C. DI.B.c. o Mise
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5
Re-pCLj r i ~ 1&1/~ ~~
/ / 't
a
PROJECT COST IV ALUE $
(excluding land)
I hereby certity that I have turOlshed 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 Illl" the
abnvc-mcntwl1cd property Jnd that all ClJllstruction will confurm to allexist10g state and local laws and will proceed 10 accordance with submlttcd plans_ I am aware that the building
(lflicial can revoke thiS permit for Just cause Furthermore, I hereby agree that the Clty official or a designee may enter upon the property to perform needed Inspections
X'~ f) <.A--> C\~7 L /0 ~ 19- 0 h
~ s#re Contractor's License No. Date .-
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
I This Application Becomes Your Building Permit When Approved
I~ ~ r fi
i IJ,,,'''m, ,ll"":" <-ilA- ! tJ It,,; / () fa I
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit i $
Other $
-
TOTAL DUE $ V/(.,,-
ThiS IS to certify that the request 1I1 the above applicJtlOn Jnd accompanYlllg documents is 111 accordancc with the City Zoning Ordinance and may procced as requested. ,ThiS d()(ument
\\'hen signed by the City Planner nJllstltutcs a temporal)' Certiticate of Zon1llg compliance and allows construction to commence Before occupancy, ;\ CcrtlflGlfC (}f Occupancy mLlst be
issucd
Planning Director
Date
24 hour notice for all inspections (952) .t.t7-9850, fax (952) .t.t7-.t2.t5
4646 Dakota Street Prior Lake, MN 55372
Special Conditions. if any