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CITY OF PRIOR LAKE BUILDING PERMIT, Rec d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
7 AND UTILITY CONNECTION PERMIT 7,,;ate
U m
4"oiNES011'
I. WhitekPity File
2. Pink PERMIT NO. ib--; ( /
i/
5
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS j� � ��
1 b`L20 W c't
LEGAL SCRIPTION(offic se only) 2�
.A_ ,02®0�.� Z
LOT BLOCK AD TIO PID
OWNER (Phone)
(Name)
(Address)
BUILDERCo i)- 1 rt. !o Y A-
(Company Name)
Scot(j LG G (Phone)
(Contact Name)
b004?14c`L re."-ti (Phone)
(Address) 3? 3 S S 'i.d"` fill e f' IS 14,4 lU STP?l2_
TYPE OF WORK 0 New Construction ODeck ❑Porch Eltce-Roofing [112e-Siding ['Lower Level Finish ❑Fireplace
❑Addition ['Alteration ❑Utility Connection
0 Misc.
CODE: DLR.C. DI.B.C.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify
at I
the ower or
zed agent
r the
above-mentio etat I have furnished informatin ondrproperty and that all constructionwill conform to alexisting stathis application which is to thee and local laws and will proceed est of y knowledge true and tcorrect.
accordance with ubm turd plan n I am awaretthat the building
official can rev ke t li,,pcor for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform neededinspections.
L ZO i
X � � Contractor's License No. P Date
Signature
Park Support Fee # $
Permit Valuation
SAC # $
Permit Fee $ $
Plan Check Fee $ c Water Meter Size 5/8"; 1";
$ Pressure Reducer $
State Surcharge
Penalty $ ' Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $$
,.-
Mechanical Permit Fee $ Builder's Deposit $ ��
Sewer&Water Permit Fee $ Other ...15:. /75 Fireplace Permit Fee $ TOTAL DUE
•01.7 When Approved Paid ` Receipt No. 0
This Application Becomes Your Building Permitpp 1 Be I
I Date
0 c�. t �
Building Official Date
Thisning
may
nt
e is signed the City Plannertconstitutes a temporary Certificateication accoof Zoninganying ocuments is in compliance andallows construction o commence.Ordinancefore occupancy,ta Certificate requested.
Occt OccupancyThis
must be
when g by
issued.
Planning Director
Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372