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Jul. 11. 2011 3:54PM No. 0908 P. 4
O PR/0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
0 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
U In
y /MmEsoil° 1. Valle me
) Pink City PERMIT NO. / / 7
) Yellow Appl;om / f
(Please type or print and sign at bottom)
ADDRESS ,. (o>rce use)
I Cc &tomr 1 ) e C(r. `�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID •
a WNER (1 K ( � -Z Cif K (Phone) 441 2 9 4g
(Address a b a ✓-e .
BUILDER �/ �Q r � •
(Company Name) Y. v e ( L O d h no j, , i o� (Phone) 0 6'2- 9 Z - 4,z (Contact Name) W' ( Y us ti,- - - �J (Phone)
(Address) ,) ONC6 611(1 t t Y t / )
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch 1Re- Roofing ❑Re- Siding ❑Lower Level Finish 11 Fireplace
❑Addition ❑Alteration ❑Utility Conn lion
CODE: ❑I.R.C. ❑LB.C. ❑ Mist.
Type of Construction; 1 1T III 1V V A B S 4 W S 0 1,
Occupancy Group: A B E F HI MR S U
pROJ'ECT COST/VALUE E S t
Division: 1 2 3 4 5 (excluding land)
1 hereby certify that 1 have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner nr authorized agenl for the
a bove•mentioned property and that all construction will conform to all existing slate and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official ca revoke this t for just cause. Furthermore, hereby agree e city o
h I hb that the or a designee may enter upon the property to perform needed mspecrons.
X r Y J �y>� 2oc�3zl % II/ I
Signature Contractor's License No.. Date
Permit Valuation Park Support Fee # $
Permit Pee S SAC # $
Plan Check Fee S Water Meter. Size 5/8 "; 1 "; S
State Surcharge S Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Pee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit S
Sewer & Water Permit Fee $ Other ` $
Gas Fireplace Permit Pee $ TOTAL DUE $ I
r This Application Becomes Your Building Permit When Approved Paid I I I Rece No.
` Date tL 1 r id / r
l uilding Otlicinl Dino J
This 1$ 10 certify Thar the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This dtscument
when signed by the City Planner constitutes a temporary Certilieate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate id must be
issued.
• -- filanning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 441 - 4245
4646 Dakota Street Prior Lake, MN 55372