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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
olio"Y 4, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /
L': AND UTILITY CONNECTION PERMIT LC) - w `
4..A'NESOl�
whue File
2 RnA City PERMIT NO. iti .
cs31
3 Yellow Apphcanr
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS ,� _ nJ ,
,5 4i ,, 11--R, Li i.- q.;-.‘Dc„, (.-7 . 7,.,,4 L��<<_ tivri
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PIDc3o3 col-0
OWNER (Phone)
(Name)
(Address)
BUILDER
(Company Name) (`70-"VD<M>i 9.C_it): G.1-+C'i1'4- V (Phone) L, `--- -
(Contact Name)
\\esu-\t (Phone)
y\c-7_,,, ��J
(Address) !:4‘.-.: �l 7)=jRtt4,,-,tiAaS‘„, 1/b-, `,aF•te--3qt>i} J'^-•--) S "'4)-"1 "1
TYPE OF WORK ❑New Construction ['Deck ['Porch la2e-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection
ID mixCODE: ❑I.R.C. ❑I.B.C. C?(--) J J
Type of Construction: I II HI IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
1 hereby certity that I have hirnished information on this application which is to the best of my knowledge tine and correct I also ceitify that I am the owner 01 authorized agent for the
above-mentioned ptopcity and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans I am awate that the building
official can revoke this peimit for Just cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to peiform needed inspections
X Contractor's License No Date
Signature
Permit Valuation �,
Park Support Fee # $
Permit Fee $ 67 4 SAC
Plan Check Fee
$ Water Meter Size 5/8", 1", $
State Surcharge $ S 04-) 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 $ `�b S
This Application Becomes Your Building Permit When Approved Paid Receipt No. q 6-147
Date (o • [to '/11 I By
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accoi dance with the City Zoning Ordinance and may proceed as requested This document
when signed by the City Plannet 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