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o f PRIp CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
U
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE g.. 2-?, �/
m
Irj AND UTILITY CONNECTION PERMIT
y'kNEso•(t' I. white File / / /
2. Pint: City PERMIT NO . t O l
3 Yellow Applicant / l
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3 IK4ilowook s+• 5kD
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER Et at Q (Phone) (9 Z)t ° — 6 T r
(Address) &+ l 611 OUJ0u1 .u,. “A)
BUILDER l (. Q ,� p (Company Name) ` ( frE (Phone) (-(fit) 38(`
.Q,Y
(Contact Name) Ii� v `/- i (Phone) `` a.)3a `
e — c t 6
(Address) - eE . S , S4- .ci. � 1J ( 1 �►
TYPE OF WORK ❑ New Construction ❑Deck ❑PorchRe- Roofing ❑Re- Siding ['Lower Level Finish El Fireplace
❑Addition ❑Alteration ❑Utility Conne do
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ 1 b ( (oci.G . —
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5 i
I hereby certify that I have hlrnished in irm ion 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 -me •ned property and the all onst uction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official ca . voke this permit for j ,ist c Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed mspecno S.
X pis ' l p \ ab ;06 9l I /a Lot
Signature Contractor's License No. Date
Pe aluation 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 $
Gas Fireplace Permit Fee $ TOTAL DUE $ 7q. 7r
This Application Becomes Your Building Permit When Approved Paid 6 f Recei t No. 4,1 j
Date ? z.,9_, t f By
Building Official Date 1111
6
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