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p4 PRION CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
ti AN` ` TEMPORARY CERTIFICATE OF ZONING COMPLIANCE w. �i /�
tr
AND UTILITY CONNECTION PERMIT
�rrNNESo� PERMIT NO �/'
I.White File �4 / ✓// /
2. Pink City
3.Yellow Applicant
(Please type or print and sign at bottom) ZONING(o ce use)
ADDRESS O ��V4` ��I Vn
3 2 �U WO cl s
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
•
OWNER y�� nn (r��nn C('�� C /I ' 1 (Phone) IX (2 �� �T
(Name) I V L I V V !VI,V 1 �,' Vl� I�' DY I (7 ,(Address) 2Ji/ V D1 v, r/ V✓Y . PV7 6rt��l✓le.e/ J. -ii
BUILDER
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BUILDER (� ��''�', (Phone) 1� I� �/✓ �O�11�Y
(Company Name) SKI. �
(Contact Name) 7aAVie` � P honeA
n. 11
`o.�Z,A�
(Address) 4100 GS/ istor ejC4` St vOU%S Pattie, IA,J
TYPE OF WORK Nddiri n s bion ODeckU�ty C nnecn t1 oofing e-Siding OLower Level Finish 0 Fireplace
DA
❑Misc:
CODE: I.R.C. �]I.B.C. '1� /(_Ill'1 , I� u
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ "��f(J V
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 true and correct. I also certify that I am the owner or authorized agent for the
above-men;.n . .,•erty and that all construction will conformeby agree that the city official or a designee ws and may enter u on the proproceed in pe with submitted erty to perform neededs. I am inspectio aware that/a building
officia permit for j i +_� O t O i f D I-1 ( r L4
X �• ' h..74, rvConon Mjtr'a7ctor's License No. l V Da e `
Park Support Fee # $
Permit Valuation # $
Permit Fee $ SAC
$ Water Meter Size 5/8";1"; $
Plan Check Fee $
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 _/�i
Gas Fireplace Permit Fee $
TOTAL DUE $/3 % . SD
/7.L � -•-iptNo. 72— �.
This Application Becomes Your Building Permit When Approved I Paid / ` S I
/=:1____
Date ‘G> is t,--(
Building Official Date /
Or
inance and may
ested. This document
his i certify thatCtheity replan a constitutes a temporary Certificate of Zoning compliance ication and accompanying documents is in
allows construction to commence. Before occupancy,proceed CertificateofOccupancy must be
when signed by theCity
issued.
Planning Director
Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372