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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� a c TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�' � AND UTILITY CONNECTION PERMIT
V � �
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��A'NES��P Z�. �n'k � Y PERMIT NO. �Z . �I_� Z
3 Yellow Applican[ ��
(Please e or rint and si at bottom)
ADDRESS ZONING (ofeice use)
l53 3 s" s c�e+- Cl�r IVE �riatr �.�c.�. h� rv
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
OWNER �-- /� r
(Name) 1 O d d � /"f � � j 5ah I"a 5 � � V1q (Phone) �J � ��7 " � g ��
(Address) l,�335 ro�e ��.✓� �ll'' N� r1�01r l�
Bi�BER U��'R1 L /�
(Company Name) Sanc�a ��0!'15'f7Ll.G'l I�OV� l.a .Tn L (Phone) 9J
(Contact Name) K u i v� Sanda w (Phone) 6/Z 363 � ���
(Address) �f 2 L nd �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing e-Sidm Q �[]Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection �dyy�g p��� �'
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $ ��DO� •
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have flirnished information un this application which is to the best of my knowledge rrue and correct. I also certify that I am the owner or authoriud agent for the
abuve-menuoned property and that all construction will conform to all exist tate and local laws and will proceed in accordance with submitted plans. I am aware that the building
official n revoke this permit for just cause. Furthermore, I here agree t e ciry official or a designee may enter upon the properry to perform needed mspections.
G�n � �' /� �GaD7� l ��//f/?—
Signature Contractor's License No. Date
Permit Valuation 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 DLTE $
This Application Becomes Your Building Pernut When Approved Paid - Recei t o.
Date , � ! B
Buildina Otticial D�te
Th�s is to certify that the request in the above application and accompanying doeuments is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consutures a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificare 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 Prior Lake, MN 55372