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oo PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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6 ,4.„ j(i_.,
4'kNESOl� I White File
3 Pink Cpl PERMIT NO. 713 Z
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
60 8; 15o s4-, Sc r.-6.0
LEGAL DESCRIPTION(office use only) C // /� /�
LOT BLOCK ADDITION PID �S s / 7 a'7, 0
OWNER
(Name) all ',3 bGLvi zi (Phone) �� �� `��DS�I
(Address)
BUILDER // �f
(Company Name) _/. . e� �Q gess% S �,, (Phone) Ce���#5/'7/Cs.°
(Contact Name) j 014 yv j2/&LLita'd 5-AA (Phone)
(Address) GLfrE'= ililk ehet ,/ 5 3/9
TYPE OF WORK 0 New Construction cgDeck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ❑Alteration ❑Utility Connection i ,
1
CODE: '12 .R.C. ❑I.B.C. ❑Misc. ' .• 1' ► --DiK� -. 1i; ' L_
Type of onstruction: I II III IV V A B PROJECT COST/VALUE $ /,3 ' /
Occupancy Group: A B E 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 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 tie building
official can r yoke this permit for lust -use F irth -more,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections
Signature Contractor's License No. Date •
Permit Valuation Ze9 00. ' Park Support Fee # $
Permit Fee $ Z3:15' SAC # $
Plan Check Fee $ 17 AA 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 $ t 2Z, ".")Gt
This A 'cat it B: wiles Your Building Permit When ppr ed Paid 12-24.09Receipt No. —L i.
�I .4. Date B, L4- ( By
Bt Idine t�ftici�, ate
This is to cer fy t i the reques4n the above application and accompanying documents s in ace dance with the City Zoning Ordinance and may proceed as requested. This document
when signe y t e ity Planner constitutes a temporary Certificate of Zoning complia ce and lows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Fiat- - or> Dat Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
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