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A r�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A °, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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w , AND UTILITY CONNECTION PERMIT
'yi H ZP I. White file - -
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1 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING @t rice use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER I • Q
(Name) � -aativ WP,�S ,, V 19 (Phone) � _ 7 - 2 (4 l
(Address) i C C � 1. S -}'1 t y Ltk t t LAc Ck G.9-eAr\-- - L
BUILDER
(Company Name) Eri Ck son go ii d i n e lit C.. (Phone) b SI - a (le - 9go c?
(Contact Name) 1,,e e ri r ksOn (Phone) b S — a 06 - 13 99
(Address) c pd 6 ?- 0D v.4 a.g e &v - z) ue P/a e (
/ )OOdhU y "MA1 S(S
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TYPE OF WORK D New Construction DDcck ❑Porch e- Roofing DReSiding ❑Lower Level Finish D Fireplace
ID Addition DAlteration DUtility Connection
CODE: DI.R.C. DI.B.C. D Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ \ i (7 • 7 4)
Occupancy Group: A B E F III MR S U
(excluding land)
Division: - . 1 2 3 4 5
1 hereby certify that t have furnished information on this application which is to the best of my knowledge true and correct. I also certify that lam the owner or authorized agent for the
above - mentioned • -..° ny and th. all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. t am aware that the building
official can .` . •e this permit f. ust cause. , . • hat the city official or a designee may enter upon the property to perform needed inspections.
6C/9 0 a9 /0
Sigma 1* Conn-actor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ F 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 I $ _ '79 7 S
This Application Becomes Your Building Pemrit When Approved Paid /79 71 Recei 14 79_ 7
Date / -3/ / 2-- . By
Building Official Date t
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