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�.� - CITY OF PRIOR LAKE BUILDING PERMIT, Ca-" Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
V
err< YAND UTILITY CONNECTION PERMIT
tNN E S°�
3.Yellow Applicant
PERMIT NO. /�. Z�,y3
type or print and sign at bottom)
IliADDRESS
l'77/ Wsf /nie ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
.Charlie Sunder
(Phone) W7 3 83
(Address) 1577/ 07°,0 4—
(Company N
BUILD /-1reuseY IO(i4jjJ .(.
(Contact Name) Mite J (Phone) �a yqa 3a�yy�
7 5-1- jitreigli MA/ 55-3 5
TYPE OF WORK 0 New Construction R ORe-Siding er Level Finish 0
Fireplace
❑Addition DAltera conn °Utiity Conation
CODE: DI.R.C. OLB.C. 0 i
Type of Construction I II III IV V A B /�—/7
A B E F H I M R S II PROJECT COST/VALDE $ ll� ,3d • Ud
1 2 3 4 5 (excluding laird)
I hereby certify that I have furnished informatibn on this application which is to the best of my knowledge true and creel. I also reify that I am the owner or authorized agent for the
above-mwtioml property and that all will moti®a to all existing state and local laws and wilt proceed in accordance with submitted
official cap revoke this permit for ase. Furthermore,thereby agree that the city official era design' �ee may enter upon the property to pIam aware tbat the buficruig
X e�fp1� 6 3a I 5-3
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Pernlit Fee $ SAC # S
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 $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Berndt When ApprovedPaid I t f
I Date (� I B No. IS—I
1I
Building Official Date
This is to certify' that the request in the above application and accompanying documents is in accordance with the City Zoning Ondmance and may moused as requested. This document
i iv,
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows constructer to commence. Benue occupancy,a Certificate of Occupancy must be
�g Dinedar Date Special Contrition,ifaay
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Miaaeaota 55372