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of rxtoR CITY OF PRIOR LAKE BUILDING PERMIT, �� Date Rec'd
0,, f TEMPORARY CERTIFICATE OF ZONING COMPLIANCE i-, 1¢.
AND UTILITY CONNECTION PERMIT ii
-,2s-. 14—
I White File
? Pink City b PERMIT NO. (4- u V
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3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
HI 1- \ ;cdd-en v ►lew eM ry L.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ,
(Name) ( ISN.) La `5 (Phone) w,/ J ("17-' (gyp/0
,9
/\
(Address) 11
BUILDER
(Company NamecTNeptWw n \A"Ysele-f&e_ \D (Phone) (05/--(9/04 4 (i0 Q4
(Contact Name) 1 lab co W
. TICI t t -e4 (Phone) 6.(i��,1�)
(Address) 6S�U�`t1'ci N 55 113 (J
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fire lace
❑Addition ❑Alteration ❑Utility Connection n�� I G � �) (,J.,Y t tl i+\
CODE: DI.R.C. DLB.C. 0 Misc. vf— _t r5
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ aI j ` I
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereb certify that I have furnished information on this application which is to the best of my knowledge ti ue and con ect I also certify that I am the owner or authorized agent for the
above entioned property . at all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans I am aware that the building
otlici can revoke this per it ' ust cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to pei form needed inspections
% � ' • _13088301 ri )
Signature Contractor's License No ate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8", I"; $
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 $
11-
This Application Becomes Your Building Permit When ApprovedPaid 2 ?ter' Recetp o. / 0
v
Date A:td
l,i( By
Building Official Date r
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 Flannel constitutes a temporary Certificate of Zoning compliance and allows constiuchen to commence Before occupancy,a Cu ti icate 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