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9 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0TEMPORARY CERTIFICATE OF ZONING COMPLIANCE.
AND UTILITY CONNECTION PERMIT ' l�
__}hN E 5
t.wrote Pik
z Pick City PERMIT
PERMIT NO. /¢ 500
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS. / ZONING(office use)
SS-7o rc," l hkc.Q Lt.„ S e.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OW(Name)
(Na ER ,..1 0 VI to b c..%., �r\. Ca.n} (Phone) 5 l 9g 3 Z Li-19
(Address) 6 C 1 `C.:; 1 des ci L� Z
C-) I! P.
BUILDER
(Company Name) 0 w0,- ._-v (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK, 0 New Construction )eck [Porch ORe-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
['Addition ❑Aheration ['Utility Connection
CODE:: LL-C. DLB.C. 0 Misc
) Type of Construction: I II III IV V A B 4t L` ,
Occupancy Group: A B E F H I M R 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 I 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. I am aware that the building
oHic ial c�a oke_this permit
for j tse rt,P��+*�,Thereby agree that the city official ora designee may enter upon the property to perform i� oos7/
(/_�-�(i Gam--' f vaF�� _� Li
Signature Contractor's License No. Date
Permit Valuation3O�v - vC� Park Support Fee # $
i
Permit Fee $ g35,2-5- SAC # $
Plan Check Fee $ 3'7,3(o 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 $ /47, / /
Ae. .,.. .•, �,- our Balling Permit When Approved Paid /4-7( // Re rpt No. VS L5'
"'Arr._ ,„--,/..---- 00 . . Date 6p / C` y
— Butldin'Z-,cial )
\1) This is to certify that the request in the above application and accompanying documents ism 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 Special Conditions,if any ,
24 hour notice for an inspections(952)447-9850,fax(952)447-4245
4.r..41 4646 Dakota Street S,E.,Prior Lake,Minnesota 55372