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oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'a
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � 9 /�
.. � AND UTILITY CONNECTION PERMIT
U �
'I► I. Whi�e File pERMIT NO. 1/� 3
2. Pink City
3 Yellow Applicant
Please or rint and si at bottom
ADDRESS ZONING (oFlFice use)
5q�q Ca ����al ��t� ��l S.�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID �.5, Z�f9 . �
owivER �/ / G/ 2l2 0 7- S! y�
(Name) A � � y !� l � � ` (Phone)
(Address) � � Y � �Q l � c. ` t � G} l !� � C( / / ( S r
BUII.,DER Pella Windows & Doors a
(Company Name)_ 15300 25th Ave N. Ste 100 (Phone) '
(Contact Name) _ Plymouth, MN 55447 (Phone) 9�/? � 3 4 5• G o Y 7
(Address) Lic # 20165884 Ph. 763/745-1400 0 C?�! t� �fQ�N' J 0l�� S
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition DAlteration ❑Uality Connection ` /
CODE: ❑I.R.C. ❑I.B.C. C�'Misc. 7 W I fl Cl�u W re f� ! Q u/ S
Type of Construction: I II III N V A B PROJECT COST/VALUE $ v� 7 �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hcreby certify that f have (vmished information un this application which is to the best uf my knowledge true and correct. I also certify that I am the owncr ur author�zed agent for the
alwve-mennoned properry and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this permit for just u Furthermore, I hereby agree that the ciry official or a designee may enter upon the property to perform necded mspecuims
,,.,,� a o 1� s a� y �a � 8���
Signature Conuactor'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 DUE $'� ��
This Application Becomes Your Building Pern�it When Apptoved Paid � Cei t NO.
Date
BuiWim� Utlicial Date
Th�s �s to certify that the requcst in the abuve applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as rcqucsmd. Thls dixument
when signed by the City Planner consututes a tempurary Cenificate of Zonmg compliance and allows construccion w commence. Befure uccupancy a Ceruficate uf Occupancy must bc
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Datcota Street Prior Lake, MN 55372
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