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Oi PR/0�P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
00rTEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
®;
•
44NEstilt'
i Pi nle
e Cit PERMIT NO. I!1-0 J', .
2 Pmt.
Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
'.54t / -& 1 Si-- 1
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ,� (Phone)
(Name) (t�I J.:4-5-,.41-4-1,-3.,"
(Address) 5 ( �� /.57) 17-&,54" c ke,‘,,,- 1„_.4. ___
BUILDER /� C�( 2—YyU _ fi �°
(Company Name) T�- CI � "'� 1� (Phone)
(Phone) 6/2.—cl5L' - S6 6
(Contact Name) L
(Address) C..[73 t 41e..r Hy 6Y2[e 72I - "did `rte...s"Z
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ,5$e-Roofing ❑Re-Siding ['Lower Level Finish CI Fireplace
❑Addition ['Alteration ['Utility Conn coon
El Misc
CODE: ❑I.R.C. ❑LB.C. 4_9/ U� `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 certify that I have furnished information on this application which is to the best of my knowledge tine and correct I also ccitify that I am the ownci or authorized agent for the
above-mention propeity and that all constiuction will conform to all existing state and local laws and will pioceed in accordance with submitted plans I am awaie that the building
official can rOtli his pet=for Just can urtheimore,I hereby agree that the city official or a designee may enter upon the pioperty to perform needed inspections
X
Sign re Contractor's License No 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 I $ TOTAL DUE $ 79- 7i-
.
97
This Application Becomes Your Building Permit When Approved Paid $7 '. 7fReceip 7T l/
Date b/ P 7� - I 7By , ,t-,,.�.:i
Building Official Date
This is to certify that the iequest in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may pioceed as iequested This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows constiuction 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