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o� ;RI?4 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
ti�AIN1 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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t. white File
2. Pink City PERMIT NO. 1 A_ " 4 - z J
3.Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS �Ep' S-7 1-I cki,+/ e 14;drie, P-70ea itivt0
17,h o.. e-ss Ke//14/4/ 5-5-7"7"
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name R 'Trevi S rei-ctea (Phone) 6( -
(Address)
BUILDER (Phone)
(Company Name)
(Contact Name) (Phone) ___---------
(Address)
TYPE OF WORK El New ConstructionDeck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish El Fireplace
['Addition ['Alterao ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 M'sc:
Type of Construction: I IIIII IV V AB
Occupancy Group: ABE F HI MR SU 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
official can revoke this permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x i „...-,. s/a9//e/
, Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 1SAC
Plan Check Fee $ ,61C 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 $ k'1 `, q
This Applic come Your Building Permit Wh Ap ved Paid ("((,47771/ Receipt No` 1 q-3 '
Date 5- 1 i I By I2 171-
Building Official ate
This is to certify that the r-quest in the above application and accompanying documents is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by City Vlanner onstitutes a temporary Certificate of Zoning comp iance d allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
ir' / I Di '� Datb I Special Conditions,if any
'll aming Director
24 hour notice for all inspectio s(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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