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- CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE -
�, AND UTILITY CONNECTION PERMIT
41A'NES�!> I. White File
2. Pink City PERMIT NO. o 1 Z
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
(P ' d - 1 . '3 �--frt& 6( five - S
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(( Na WNER �i 1%t„/ /' I t L L� {t ,�'�v2' . 1 (Phone) fiS — 7 7
(Address) 1 l.G 1 ' -4--(A -a L A f/ e - s E_-
BUILDER Oudget Exteriors
(Company Name). 8017 Nicollet Ave S. (Phone)
(Contact Name) _ Bloomington, MN 55420 (Phone)
PH: (952) 887 -1613
(Address) F: (952) 887 -1659 .'"Ai
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ['Re-Roofing Re- Siding ['Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ['Utility Connection ❑ Misc.
/ .1 4)
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CODE: DI.R.C. ❑I.B.C. PROJECT COST /VALUE $ / v , ( " 1
Type of Construction: I II III IV V A 13 (excluding land)
Occupancy Group: A B E F HI MR S U
Division: 1 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 1 am the owner nr authonzed agent for the
above - mentioned property and t t all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official c re e this p for . t cause. Furthermore, I hereby agree that the city official or a designee may enter upon the prow, iy to perform needed inspections.
x/ ` 1i11 , 'i. l-- a/ —' I 1
Signature Contractor's License No. Date'
Permit Valuation Park Support Fee # $
Permit Fee S SAC # S
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; S
State Surcharge $ Pressure Reducer S
Penalty l $ " Sewer /Water Connection Fee # S
Plumbing Permit Fee { $ Water Tower Fee # $
Mechanical Permit Fee S Builder's Deposit S
Sewer & Water Permit Fee $ V Other S
Gas Fireplace Permit Fee S TOTAL DUE $ vI C9 .7j
This Application Becomes Your Building Permit When Approved Paid 7 9. .2 5 Re pt No. / 0 1 06(,
Date z - _ 2...r.1 / B
Building Official Date
This 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
when 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
issued
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
16200 Eagle Creek Avenue Prior Lake, MN 55372