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���% R � I \� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec' d
v j� i \� �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �/ Z �/
~ � �__�/ AND UTILITY CONNECTION PERMIT
�
� E S��
Z: � ��, PERMIT NO. I I l� �
3. Ye1bw Applicant �. � �
lease or ' and si at bottom)
ADDRESS ZONING (ot&ce use>
l60�10 /�ar(cc�c.t� � S�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ` � r_
(Name) V � K �TJ� S. � l�C� - - (Phone) �Sa-- �G a- - G �
,
(Address)
r �� 1 �„ v"'/ ��./V '�l W WJ �i � /
�COmr. Name, + � ctz. .��_ (Phone 6!� - 6�-Y- 7 0 6 g
(Contact Naxne) � rre K/✓v l 1�t (Phone) C�/� -��-� 8 2 y
tAaaress� 333 ��.,k �-. . iV � � � dLl�l �s�to�
TYPE OF WORK ❑ New Co�ucuon pnedc pPorch -Roosng ❑Re-Siding pLowvver Levet Fmish ❑ Fireplace
�Addition ❑Aiterat�n �Utility Connection
CODE: �I.B.G [11.B.C. ❑ Misc:
Tppe of Conshncbion: I II III rv v A B �
Occ�y G�up: A B E F H I M B S U P80JECT COST/VALUE S L7-��
Division: 1 2 3 4 5 (ezcluding land)
I heieby ce�6fy that I Lave furnished infarmarian vn thB app�n which is Oo the bes[ of my knowiedge tme and ooixecx. I aLgo ariify that I am the owna ot� antl�rni:ed a�ent far the
abave- pmpecty and thaz ail 000stcuct�on will mnform to all eristing stare aad laal laws and w�l pioceed 'm aconrdanoe with submiued plans. I am aw�aze that the building
official this ' for ' Furthamore, I heieby agee that the dfy offiaal � a desi�ee may enter up� the propecty to perfmm needed in�ons.
X �D(� ��Z3 �'� �7" ��"�/
sigoa conuactor�s Lioe�e No. nate
Permit Vatuation Park Support F� # S
Pernut Fee $ SAC # S
Plan Check Fee S Water Meter Size 5/8"; 1"; $
State Surcharge S Pressure Reduoer $
Penalty $ Sewer/Water Connection Fee # S
Plumbing Permit Fee $ Water Tower Fee # S
Mechanical Permit Fee S Builder's Deposit S
Sewer & Water Peimit Fee $ Other S
Gas Fireplace Pernut Fee $ TOTAL DUE S , �
'rhis Appli�tio YaQ B�dins �� At�o� Paid , R t No.
Date B
�.lL,(,� °
Build" cial Date
This is to cenify request in dx above applica�n and a000mpanymg documeots is in acowdanee with the Ciky Zoning Ord'mauce and may pdooeed as nqoesoed. This document
when signed by t� Planner � a oemporacy Catificate of Zoning oompliance and allows oon�uction ro commenoe. Befare occapancg, a Ceitificaoe of Oocapancy must be
issued.
Plaming Diredu D�e Spacial Ca�fioos, if �Y
24 hoor aoUce for all inspections (952) 447-9850, faa (952) 447�245
4646 Dskota Street SE., Prior Lake, Minnesota 55372