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CITY OF PRIOR LAKE BUILDING PERMITDate Rec'd
; TEMPRYCETIFICTEFZIGCMPLIANCI " j
I. White
2. Pink C ((��//City Cit 1. PERMIT NO. 15//�� I I
��NNEOlt.
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
--'=' ADDRESS povoLi-Atee
�� ����
/9o9/ l�(44w j/ tEk)
LEGAL DESCRIPTION(office use only)
PID
LOT BLOCK ADDITION
46 O(NWamNeE)R 4dive, gAeyey P6c4s-,i-L(o( (Phone) q s",1 .- /7f d 71/
/
(Address)
BUILDER (Phone)
(Company Name)
(Phone)
(Contact Name)
(Address)
TYPE OF WORK ❑New Construction
❑Deck ['Porch DRe-Roofing DRe-Siding ['Lower Level Finish IDFireplace
DAddition DAlteration ['Utility Connection �j 0 .54-0
ElMisc. (J,' `
CODE: QLR.C. DLB.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
t
I hereby certtionify thated I haveproperty fila that all eonsu[totion wills onformiotonn all existingo state and lfocal laws and will p o e d ti e accordance wi h`s bm tt d plan n Ir aimr a are that the bt uilding
obfve-men
official can he this p it for just arse urthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X Contractor's is License No. D
Signature
Park Support Fee # $
Permit Valuation 5-61 0, # $
Permit Fee $ "1-5SAC 5 $
Plan Check Fee $ Water Meter Size 5/8"; I";
tco-E. Pressure Reducer $
State Surcharge $ , $
$ Sewer/Water Connection Fee #
Penalty Water Tower Fee # $
Plumbing Permit Fee $ $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $
TOTAL DUE 41_Zc.,
—// Receipt No. CP
This Applica Becomes Your Building Permit When A prov DatePaid ./5 By f
i Of ficial t)""
Bud _f
This is to certify that the e.ucst in the above application and accompanying documen s is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Cit ' ner onstitutes a tem orary Certificate of Zoning compli nce d allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
LSpecial Conditions,if any
'.annin'Director I to
24 hour notice for all i spections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372