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o � PRIp� CITX QF PItIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CER.TIFICATE OF ZQNING COMPLL4rICE C; �
U � . _ AND UTILITY CONI�IECTI4i�i PERMTt �.� (-� 5
��HNSSO4* t. wlw� � PE1t1l�IT NO. �
2. i5o1: Cay
3 YBbw AppFnn
teas� or tlnt and si at bott '
ADDRBSS - ZONING(otsecuu)
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LBGAL DESCRIPTION (oft5ce use only) '
LOT BL�CK ADDITION � PID
(Nam B ti)Y � C�� 1 l l, Y�Y�� - (Phone) 1 JZ� � U� ���,lU�
(Addressj � ` � . � 1 1� 6 � .� _ ✓ - 6
1�9 �
BUII.DER —�
{Cornpany Name) �r"! Ck SDrI �U 1 � c�i �1 a �L.� } G . (Phone) `sl ' a y� ` 9 c� �9
{Contact Name) L e e �("� �/CSOr'1 __ (Phone} b S�� a p b � 3 9� -
{Address) a�d � �� 1/� l�� N s�i as
TYPE UF WORK ❑ Niew Coinrivction �Dcck OPorch e-Roofiog �Re.Si�ng [�Lower i.evel Finish ❑ Ftreplave
DAddition DAlteration pUGliry Cannecaon
CODBc QI.R.C. []I.B.C. � M �' � j1,,, 4 � ]
lppe of Constzuction: I II III IV v A B pROJECT COST/VALUS $ Vl J(� '�
Occuparicy Group: A B E F H I M 8 S II E ��� �
Division: 1 2 �3 4 5 '
t hue6y cerafy t�t [ fiun' in[ormatioa on this applicallon wt�h is w �he bat oFmy knowicd�e hne and toaect t also artify that [ vn the ovmer � anthoriacd agcM for the
abott�-mentioned artd a![ rnratntction ' form to aD exisHng stue az�d loc�! Iaws artd wli pcDCeed in accondanae wifh submitted ptans. I am awue ti�at tEre build[ng
a6xial can Urisperm+t just causa triat the citY otficial a a daigaee may enter apcun tFu psnperty m pc�far�n necctcd ir�apcetions.
X �� SC� 9 s� a q s�a Q ia
Signaturc Contiacror's License Tio. Dare
Permit Vataation Pazk Support Fee # $
Pcrrnit Bee " � S SAC # S
Plan Chetk Fee fi � Wattr Ivleter Siat 5/8",1• S
State Surcharge S �� g��� S
Penaity $ Se�verlWater Conncction Fee # • S
Plumbing Permit Fee " � Wacer Tov�r Pe�e # �
Mechanical Fermit Fec S- Buiider's D�OSit S
Se��vcr & WaterPemtit Fee S Other S
Gas Firepla� Pecmit Fee � TOTAL DUS S
This ApplieaHon Ba+omes Ya�rBullding Peemtt Whea Ap�roved Paid No.
Date B
Build" Ofiicial Date '
77,�s is co catiry enac cuc rcquesc in d�c anove application a„a aocompaery;ng aoeumean is 5� aKaaaaa vraH rhe cSty zoa�'v,g ora�wanomai� may gracooa as �• rnts aaca,x�u
when signed bg the City Plnnnet co�nstituta a umpwuy CeRil3eaEe of Zonieb tar�s�ue aad aIIows constructfat to eoa►meuce. Btfoiie occupanep. a CertifiWe af Ooeup�ney must be
�uued.
PIam�Lng 17d�ector
24 dour �oficc Iorail inspecdons (95�j 44? 9850. tax #9S2) 4d7-4244" .
4b�6 Dakota Street Prior Lake. MN 553?2
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