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OF PRI( CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 9 7 / /
.. AND UTILITY CONNECTION PERMIT
U
414'HES0.0' I. White File
2 Pink City PERMIT NO `/ , 8 0 /
.
3 Yellow Applicant
rint and sign at bottom)
ADDRESS ' ZONING (office use)
3 $/4/ PM 541 rn, S s-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) 4U "T 4 C,� Ch &Z- 6-6° E'v (Phone)
(Address)
: ': ; - , / � q
4
(Company Name) W,C'J� GYO /7� C' 0,7 L L L (phone �^ 730 - 77�/
P
I (Contact Name) &i 'V, 5 J5C /js/ /41114'3 (Phone)
I Address) ,j /G/ / A9.2 e^
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ['Utility Connection — 60c114 h-00 t - 1
CODE: ❑I.R.C. ❑I.B.C. El Misc. `
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5 1
1 hereby certify that I have fumished 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 - mentioned property and that all constructil 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 re his ermit for just,use. F , I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ontractor's License N Date
J
Permit Valuation Park Support Fee # $
Permit Fee $ 3 S 2 s SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ . Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ y V Water Tower Fee # $
Mechanical Permit Fee $ � , Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ S9, 7,G
This Application Becomes Your Building Permit When Approved / 9
PP B PP Paid � 9 7r" eipt No. � (��
Date 9, 7„ t / B .
Building Official Date
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
Residential Building Permit Checklist
.11'I ^III 1 1 11 •\ • 111 y Homes
BY: Date: I/
Building Permit # PM: Zoning:
Site Address 3 9/1-- P02,17-0
Legal: L B Subdivision:
Existing Structure: S or O
CONFORMS TO ZONING YES NO
ORDINANCE
I YES ' NO
Is this an expansion of the existing footprint or Refer to Planning
building height? ✓
Is the property located within the flood plain? Refer to Planning ✓
Does the alteration include any additional kitchens? Refer to Planning
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors?
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED. IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
•
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