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From:LES JONES ROOFING 952 881 7009 07/21/2009 12:10 #655 P.002/003
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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE JUL 21 2009
to AND UTILITY CONNECTION PERMIT
' NE S D � BY
I. White
2. Pik City PERMIT NO . / .
Pink Cit
3. Ycllow Applicant �t 1
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N R ! / G'. /i- '� (, 5 ?G --r-e-e (Phone)
(Address) (' 5 /`f - 6.0 ci-c,A - ?r?
mnyName)4PS T -P S '` ... -- • (Phone) 9!.t - rg / "
(Contact Name) _do • . cc.-7--- v (Phone) "/ 5 - ?- Y / * . - 44 /
(Address) 6. P--i/ 0 , 3 0 72 97-74)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch e- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I 11 III IV V A B ,� (( . �
Occupancy Group: A B E F HI M R S U PROJECT COST /VALUE $ 7 / /. CV
Division: 1 2 3 4 5 (excluding land)
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 or authorized agent for the
above- mentioned property .. t 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 o this p - t for ju • cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
(Dk.5 Co 1 7,2)-o
Sig Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; l "; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
PIumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 76 ,,,�
This Application Becomes Your Building Permit When Approved Paid l67 Recei 0. 4J1
Date 7, ,.. By
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
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
41 4 f At
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