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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec' d
(DP � PR /p TEMP ORARY CERTIFICATE OF ZONING RM TPLIANC
AND UTILITY CONNECTION P
�,
"'/ nxHes °o 1 WI, hite File PERMIT NO.
V 2 Yellow A A ' cant
Please , • or trim and si at bottom) ZONING (office use)
ADDRESS a t 5 p, .53
�
LEGAL DESCRIPTION
office use only) ,
PID
BLOCK ADDITION P I P y LIT -tag Or
LOT (phone)
OWNER �r
(Name) .a.
(Address) oSI o �1 0 L1- - y ��
( (Phone)
BUILDER _ • = .16. (Phone)
I (Company Name) �� 16. � X1
(Contact Name) es - . �e_U, \ \Z • (An" J2ric,-vb
❑ Re- Siding ❑1.O`^'er Level Finiil
(Address) \WOQ Porch ❑Re- Roofing 3n(� Lev C
Deck ❑ V)1/4-0/ Lo (,tJl r�lY' , !
CI N Construction ❑ ❑ Utility Connection %1.18isc. JECT
TYPE OF WORK ❑Addition ❑Alteration PROA.
COST /VALUE $
I B.C• . IV V A B (excluding land) []I.R.C. ❑ I II III M R S U
Construction: E F III t nt bu fur d the g
Type of Consttu A B 2 3 4 5 that I owner ur au orized ag'
Group: 1 a warc th that the ilin
Occupancy submitted am the plans t am
6nuwledge true and an�ect 1 also ceruty tenons.
Division: toceed m accordance wiS� perform needed inspections.
lication which is to the best of my enter upon the p P
state and local laws a nde map
agree that the city official or a designee 1 hereby certity that 1 have hirnished information un this ap i� (�' �
ropcny and that all cunsnuction will c 1 hereby gll exisung / G\ `� `�
I a mention permit f ist cause Furthermore.
official can r� a this p ` I S ^
(� `" — Contractor's License o Date
I X Signature , park Support Fee
Permit Valuation Size 5/g" 1 '
Water Meter ljIIIIIINIIIIII Permit Fee
Pressure Reducer Sewer /Water Connection Fee #
plan Check Fee
#
Water Tower Fee
Penalty Deposit ee
i t Fee Builder's faIIIIIIIIII
Plumbing Perm Other ��
Mechanical Permit Fee TOTAL DUE
Sewer 84 Water Permit Fee IUIIIIIIIIIIIIIIII 10111111111
Gas Fireplace Permit Fee
Recei.t _ AIMIIFSIIIIIIIIIIIII
Approved Paid OM B
t When ApP Date /OM /
This Application Becomes Your Building Perms
may Proceed as requested. This document
Date
Buildin" of must be
Zoning Ordinance and � Certificate of Occupancy
official Before occupancy. •
application and accompanying documents is in accordance with the City
utes a temporary Certificate of Zoning compliance and allows construction to commence
This is to certify that the request m the above
Planner constitutes Special Conditions, if any
when signed by the City
issued D ate 952) 44� 4245
(952) 44'1 -98 fax
Planning Director inspections ( MN 5537
24 hour notice Street Prior Lake,
1646 for