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of PR CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
4t'NNESO�� I While File PERMIT NO . �� J y
3 pink Yellow Applicant / l �y /(" / ) C.
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3
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
Li csri ct K imi\x `tkL ■K
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNE 9 �), 463 ci4s (-t 0
(Name) �.� ( Phone) 1,
(Address) l („q- aVrA (1 9 ra,
DER
I l f A k 45
(Co(Company Name _ G = ... ' +. .- � 1.--LC.... (Phone) o�
(Contact Name) L Ak (Phone) ( e)- S 3 Al S
(Address) `fit a Lk s O&
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch N4-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ['Utility Connection
CODE: (I.R.C. ❑I.B.C. ❑ Misc. �n
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ a 000_
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that f have furnished information on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above -men 'one property nd 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 c. , v (e this per it for lust cause Furthermore, I hereby agree that the city official / or a designee may enter upon the property to perform needed ins ections.
ir Signature Contractor's License No. Da
Permit Valuation Z 0« . Park Support Fee # $
Permit Fee $ 'T -7s SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ '5", — 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 $ `7 q •7>
This /� .tic. ion Becomes,Your Building Permit en proved Paid 1 ` 7) Receipt No. 63 1--/Z6 Date 7.Ze) ( By �1
I ZO 1/
. uildii D. e.
This 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
when 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
issued
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372