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of PRio. CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
AND UTILITY CONNECTION PERMIT 6 t i,j
ylnneso'tt.
1. White File p�; Q'
(Please type or a d w A,tyPERMIT NO. �,/•��U
print and sign at bottom) ins
ADDRESS
J (3/ O ZONING(office use)
p coEt..3 v(LW Lt)
LEGAL DESCRIPTION(office use only) .
LOT 1 BLOCK'-'c ADDITION 0t
= I I; s Rt--, `;<,z-,27-i-t PID;275— 05-- 0 20'69
(oNwNER ri oQ S"i-,t,,(Eli // -- n
(Phone) (,o 0- %9 R I -3_57S--
(Address) 1 —1-12 g (7°LoC. 0 1 L.c..-
BUILDER C t Ce. t. 8 CSSJ
WS
(Company Name) fms—e -1?-- �
(. Oker)
LLC' (Phone) 95,A- SZ.o- 3376
(Contact Name) Si /) /4 C✓e.Sc)1,-)
(Address) 7 � � � r- (Phone) c-75-1.— SCyJj. ... .1-76
TYPE OF WORK 0 New Construction Deck OPorch
• °Addition DAlteratio ['Utility Conne ti ne-Roofing ORe-Siding ['Lower Level Finish ❑Fireplace
r
CODE: Ii ' .C. ❑I,B,C, 0 Misc.
Type of 'onstruction: I II III IV V A B -
Occupancy Gr roup: A B E F H I M R S U PROJECT COST/VALUE S 140(,6
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 owrnr or authonzcd 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 c. . ermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. 6— q^ /�
Date
Permit Valuation Park Support Fee #
Permit Fee �7t'}a, $
$ cegz5 SAC # $
Plan Check Fee 7
$ ,. t3 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 $
/
x`7 '7. //
This Applic s`n : . , ,. : Permit ' , n A ,ved R � Ail
4 q•/�, p' Pai ` Receipt No_ g�.0 fi I Date 1By.111
13 d , ,a Official \� , J
Date
This into certify t,, he r'tuest in the above application and accompanying ooc en is in accordance with the City Zoning Ordinance and may
when signed by •ity nner constitutes a temporary Certificate f Zonitom li nee and y proceed as requested. This document
issued. g P errs construction to commence. Before occupancy,a Certificate of Occupancy must be
(f f r/
��''lanning a- _ 1 Date
--..,--...---.✓ 24 hohr node for all inspections(952)447-9850 Special Conditions,if any
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4646 Dakota Street Prior Lake,MN 55372
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