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o F PRI CITY OF PRIOR LAKE BUILDING PERMIT, � Date Rec'd
,, .`' . � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�' � AND UTILITY CONNECTION PERMIT
V �
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��`�'NES��P 1. White File .
2. Pink ��� PERMIT NO. �Z _ Z g 7
3 Yellow Applicant
(Please e or rint and si at bottom)
ADDRESS f ZO G( fice use)
` � � r c,l�C. � ��
i�y58 �� h��� �
LEGAL DESCRIPTION (of�'ice use onty) `�'
LOT BLOCK ADDITION PID . 3 �-
�aWNER�—'"�;�M 1�`�USe. � (Phone)��o�" �g� ��v�
��
(Address) �'�-t US g N 1� � 1 ' �� t rGI e.
BUII,DER � �� A 5a ' G�5 '`( a.a.Co
(Company Name) �� Ic-oo� � c�:+�d �'�e-'crioc�.�t'^fi� (Phone)
(Contact Name) ��.ar�G �\�c� (Phone)
(Address) ��(�O €,�c(�t,\5+pt' 1 � . �S avK �J�`J� ��o
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ,�Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: I.R.C. ❑I.B.C. ❑ Misc. „
Type of onstruction: I II III N V A B �+�/ /�
Occupancy Group• A B E F H I M R S U PROJECT COST/VALUE $�Q� 0 UU�
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fiimished 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 construction wil] conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can voke this permit for just cause. Furthermore, I hereby agree that the ciry official or a designee may enter upon the property to perform necded inspeccions.
x o�.��cirvn.� U�� C'�R� � (��'� � ��? ���—
Signature Contractor's License No. Date
Permit Valuation 2 �� 0 .-- Park Support Fee # $
Permit Fee $ 1 � � SAC # $
Plan Check Fee $ Water Meter Size 5/8°; 1"; $
State Surcharge $ F�'� � Pressure Reducer $ V
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 $"'( �,'1 '—
This Ap rion co es Yoar Building Pemvt en proved Paid Recei t NO.
r Date B
4 �7 /v
Buildm - .��I D te
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 requcsted. This document
when signed by the City Planner constitutes a remporary Certificate of Zoning compliance and allows construction to commence. Befare occupancy, a Certificatr of Occupancy must be
issued.
Planning Direetor 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