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Building Permit 14. 0090
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City -"" t Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) /6 0 Ci \ UU - ..- S k— A v 5 . c:' LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER A. e t —� : Phone (i✓I C; �. 1 5 y C= (Name) � v .� � v\ �. wax.� t;r1 S � '' ''' (Phone) v cc (Address) BUILDER (Company Name) - t' 'A- r � �.' \S C v �. „� (Phone) '( )_ 3'& . .5 `( (Contact Name) C C7--' C2..C V-1(:-.1='. (Phone) 5 /'Y"\t' (Address) `7?'7C G,1,r,`e.-c.c - C .\ ,N G. �� , 0: L..,}c, 1 Yv\,,i, .S S 3?i TYPE OF WORK 0 New Construction ❑Deck OPorch Me-Roofing ORe-Siding .ower Level Finish 0 Fireplace ❑Addition ❑Alteration ❑Utility Conner on `Nb.77140‘; _ q� CODE: ❑I.R.C. ❑I.B.C. 0 Misc. b771 l0L6 WA- 1,L Type of Construction: I II III IV V A B PROJECT COST/VALUE $ Occupancy Group: ABE F HI MR SU (excluding land) Division: 1 2 3 4 5 I hereby atily that I have furnished information on this application which is to the best of my knowledge true and conect I also certify that I am the owner or authorized agent for the above- e tinned prop rty a that ail co so uction will conform to all existing state and local laws and will proceed in accordance with submitted plans I am aware that the building officia ca revoke this el for Just u c Furthermore,I hereby agree that the city official or a designee may enter upon the property to peitorm needed inspec tons Signature Contractor's License No, Date / Permit Valuation 3, C:00. 0C) Park Support Fee # $ Permit Fee $ e 0acs-'" SAC # $ Plan Check Fee $ 57 3(, Water Meter Size 5/8"; 1"; ....._$ „----------- State Surcharge $ Pressure Reducer / $ Penalty $ Sewer/Water Connection Fee # $ Plumbing Permit Fee $ .SC 7 _I'rr- Water Tower Fee # $ Mechanical Permit Fee $� atsa?� Builder's Deposit $ Sewer&Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DUE $/4 7 / This Alie ion Becomes Your Building Permit en Agroved Paid , I Receipt N�[on. 1701 Z- i .—_ __ // Date r By V'� 4 til Da This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may pioceed 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