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(641, ,,P11.0'414 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE A N D UTILITY CONNECTION PERMIT 3. z 9 /
1.7 C
I. white File
2 Pink City I PERMIT NO /Z Z10 I
.
(Please type or print and sign at bottom) Yellow Applicant
ADDRESS
ZONING (office use)
F S3 3,
f' 112/ , , 00 ✓ Z. /rt de .a.dr t
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER // �� / / / �/
(Company Name) //T` /ii >s 5, { � t / `3i'''lq/W. s h f (Phone) ,., — . – / ��
/2';
(Contact Name) e l e C, J
(Address) fe -e S (Phone)
TYPE OF WORK ❑ New Construction ❑Deck
❑Alteration Porch )r: Roofing ❑Re- Siding Lower Level Finish ❑Fireplace
❑Addition ❑Utility Connect
CODE: ❑I.R.C. ❑I.B.C.
❑ Misc.
Type of Construction: I II III IV V AB
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official can revo. • this permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspe wns.
Signature
Contractor's License No. D
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
$
This Application Becomes Your Building Permit When Approved 9 7S eip
//--
Paid t No. 4P
/
Date Z, . (.)- I R 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
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 Special Conditions, if any
4646 Dakota Street Prior Lake, MN 55372