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PR.4- CITY OF PRIOR LAKE BUILDING PERMIT, C. Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 7 Z 4_,r4---
.. n AND UTILITY CONNECTION PERMIT
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4./R'NESo1P. I. White File �/
2. Pink City PERMIT NO. /`-._ -7/ 7
3 Yellow Applicant
se •e or .rint and s,gn at bottom)
4tringlial OPP ZONING(office use)
/W7/be/170 &9/2oflL) e
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER D
N `'�� '
ame5) 4 LUt/'J fh(ik y (Phone)
(Address)
BUILDER P —, I i / f OF
2pany Named . u i e ► ,i /.' aAI�� (Phone b
Qfact NamA.UL i_oe-17/'j ,'n ,���j/� (Phone)
resslb tel/ I'1 " 3..itim'I�/Uk��''(C�
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YPE OF WORK ❑New Construction EDeck ❑Porch ire-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Con ect .n
ODE: ❑I.R.C. ❑I.B.C. ❑Misc.
e of Construction: I II III IV V A B PROJECT COST/VALUE $
pancy Group: ABE F HI MR SU
(excluding land)
vision: I 2 3 4 5
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 pro erty and hat all constructio will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
of ;al can revoke th.permit rjust cause. Furth,more,I hereby agree that the city official a designee may enter u.on the property to perform needed i .ection'.
- / . /IrI ...Lair/
o ractor's License o. � �
iew
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 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 $ /J !J�
Gas Fireplace Permit Fee $ TOTAL DUE $ — / `...........____ ,
This Application Becomes Your Building Permit When ApprovedPaid 7 (' S • Ceipt No. 1< /
Date 7 Z,,,� rc/
Building Official Date /
liis to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
tied
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