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0rxta� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ti . TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT a'd
�iNN860It' I. white File PERMIT NO. / 71 Z_
2. Pink City
3 Yellow Applicant
ease type or print and sign at bottom)
ADDRESS AfZONING(office use)
..- 7041 p.aS k r'�a S f. s,,, Peter Leda , Coal fc3")i/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)OWN
r`
w• kfa tIS (Phone)
C
(Address) 37oq Perchh, S fi- St,/ Poo LAki, fil 4,1 53-37)
BUILDER �jf/),�
(Company Name) / Tl 1$6t-r Co St cel P ,? i.i ria/ L 1-c- (Phone) C15�� '- 6 "-Soto v
(Contact Name) �`e t'-p (Phone) 61 d.• a/0 -5.-q6.1
(Address) 57L t ciqf rrievl -r e t- 4103 1(1,60.e. PIcA ,v74) 5'S.,S-4/
TYPE OF WORK 0 New Construction ['Deck ❑Porch We-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition DAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc.
ype of Construction: I II III 1V V A B PROJECT COST/VALUE $ l°�, o�®
vision:
cupancy Group: A B E F H I M R SU
1 2 3 4 5 (excluding land)
i
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 property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this r it fo lust cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x 6C 6fo 3Sa2 o-,11-i5
Signature Contractor's License No. Date
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 $
Gas Fireplace Permit Fee $ TOTAL DUE $ 9
This Application Becomes Your Building Permit When Approved Paid 71 '75' R eipt No. ` W
Date G , 21- cG.S�
Building Official Date
is 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
n signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction tot commence. Before occupancy,a Certificate of Occupancy must be
cd.
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake.MN 55372