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ti 4' AN,i CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
c.> r=7 AND UTILITY CONNECTION PERMIT 7• Z , U
r A'NES° 7
1. white File
z. Pink City I PERMIT NO. 0 94, 05 6
(Please type or print and sign at bottom) 3. Yellow Applicant
ADDRESS
ZONING (office use)
a2Fl ?S cp , /19 L0,,A �'d. , el-,or Zc. ifi SS�32
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID 2 /'33, ors 0
OWNER ) //�
(Name) ✓' !c / -e. i /R 7
(Phone) g CV? - /y6. - 49.3
(Address) 2S9 <c),.-.. La , •-e , i. % r , or L / z � / � N
S75 7.Z
BUILDER (7
(Company Name) ,..c /l� }lryn -,S a..-2c-i. a-hre jt y o e hone) ('!.2 302,' -O 9GQ
(Contact Name) 7# f.• (Phone)
(Address) A, / - 7:; , , 4 v /' . j La c° iv, 1/-- , /V . ICY /
TYPE OF WORK ❑ New Construction o Deck Porch CRe- Roofing We- Siding ['Lower Level Finish ❑ Fireplace
DAddition DU OP Connection
CODE: I.R.C. DI.B.C. /Z.41 414111 f Ef Type of Construction: I II III IV V AB
Misc: Al c t ,) (t>, �)�
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $. Si O()0
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 I am the owner or authorized agent for the
above - mentioned property and that all co. struction 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 permit for just ca) . Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature aOS�>YC� � — 2 d
Contractor's License No. Date
Permit Valuation Z. J—O 0 , a V 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 $ 16. U r,
Paid /
This Application Becomes Your Building Permit When Approved 4 + vv V
7 I R ipt No. Si {sr
Date 7 L,I, l I
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
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, proceed as requested. This document
must b
issued. a Certificate of Occupancy must be
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