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PR °Ot.
t CITY OF PRIOR LAKE BUILDING PERMIT, 0../ Date Rec'd
f
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT Be 2 7 - ((-1
UxjNES >/'
1. white File2. Pink City PERMIT NO.3
Yellow Applicantse type or print and sign at bottom)
ADDRESSZONING(office use)
14 LOl W IA ct I Ztc9e Ni ?UD
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PIDeac'• 1 b `
OWNER
(Name) (Phone)
(Address) //
BUILDER �(� �SZ- Z24' fZl�
(Company Name) -I 1 V f\6 C d , - (Phone) SiContact Name) (7 Ca.el d nvi 1 V td `cAr L (Phone) �l��' Ci3®
(Address) [S7() id,,„, i..e R i , idol. p(t`i ' C 0.1 YV 5'63a(.0
TYPE OF WORK ❑New Construction ['Deck ❑Porch gRe-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition EAlteration ❑Utility Connection
4ODE: ❑I.R.C. ❑I.B.C. ❑Misc.
e of Construction: I II III IV V A B PROJECT COST/VALUE $ i 0/ CO000
panty Group: A B E F H I M R S U (excluding land)
ivision: 1 2 3 4 5
I hereby certify that I have burnished 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 .rop°rty and that a construction wil form all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official - rs r'i•permit fo )us taus Furt ore -reby'gree that the city official or a designee may enter upon the property to perform needed inspections.
x o
Signature Contractor's License No. ate
Permit Valuation --'] Park Support Fee # $
Permit Fee $ /4" SAC # $
Plan Check Fee $ / r Water Meter Size 5/8"; 1"; $
OD
State Surcharge $ L Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $ 7C/
/J�
�.•5
Gas Fireplace Permit Fee $ TOTAL DUE ,
•
This Application Becomes Your Building Permit When Approved Paid 7,e-t. 5 Receipt No. 7c9 16-6Date2-2 't cl
By 50-44.,..)
Building Official Date
ilis to certify that the request in the above application and accompanying documents is in accordance with the CityZoning Ordinance and may proceed as requested. This document
n signed by the City Planner consuhites a temporary Certificate of Zoning compliance and allows const action to commence. Before occupancy,a Certs icate of Occupancy must be
!issued.
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372