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��PRI0�
CITY OF PRIOR LAKE BUILDING PERMIT,
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TEMPORARY CERT'IF'ICATE OF ZONING COMPLIANCE Date Reed
fir ,,r) AND UTILITY CONNECTION PERMIT
,„„ 61,1-fp
1. White File
2. Pink City I PEST NO. 1
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(Please type or print and sign at bottom) 3. Yellow Applicant / )
i ADDRESS
•
I I L0- 0 h i I cA Tr I W, `I 1 I o v W �- T' I 1 I k, �� -i a ZONING (office use)
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1. LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER j n\nnl Leann \AnvAtknhor
/,' 9 (Phone C � � ,
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(Address) Ilf/� Arno jri cr- ) Prior 1c� Yi m \i Y J a.
BUILDER
(Company Name) (Y- ti.ZaYV, 1^-4 Fi/' 44 L� I� II
–'� �.� Uv�` � 1 '��-� . (Phone) `e � i - 7 S mil' - � � `-Y k�
(Contact Name) –�CS 1- Z z / r / /
(Address) Ltd' C� C4 „ Q c An ��-- m N sso ( ju y e� eustomr ` - / t emodel ` e f rs t iine.eom.
TYPE OF WORK 0 New Construction []Deck OPorch
ORe- Roofing ORe -Siding
OAddition OAlteration ❑Utility Connection °W� Finish ❑Fireplace
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CODE: ❑>.x.c. Di .c. �� I lK hre
Type of Construction: I II Misc: J� 1 r�c� I�r ; a J �� cinl) rs
iQ ry V A B
��P7np: A B E F H 1 M R S U COST/VALUE (��
Division: 1 2 3 4 5 PROJECT Ian ) $ t!1� �
(excluding LI<nd)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
• above - mentioned i • •arty and that all construction ' conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revo e this .:..'t for just cause. Furth: .■ ore, I hereby agree that the city official or a designee may enter upon the property P P to perform needed inspections.
X � +� e- �2 od /74/8 a,i8'. , 5
Signatur Contractor's License No. o. Date
Permit Valuation _ 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
$ '71 76—
This Application Becomes Your Building Permit When Approved Paid
:7 I Receipt 0. S r
Date ,,e -42. � B / 7 j
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
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 Special Conditions, if any
$646 Dakota Street S.E., Prior Lake, Minnesota 55372