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ti�^ � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�` ��,'�� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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"��; �; �' AND UTILITY CONNECTION PERMIT
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�. wh+�e File pERMIT NO. /J
2. e�� c��y / � . `� � �
3. Yellow Applicant
lease e or rint and si n at bottom
ADDRESS ZONING (otfice use)
I � 39 Z 1�ee � - F i �e. �� �r S , � . /� P�o 2 �a l�e .'�'!�l/
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
� �O �1 ✓'1 �UvIJ d�.' .5 � � (Phone) l � Z `� � � 7 '� � � ��
(Address)
BUII,DER �/�
(Company Name) SO �O�r' L " "�'�� . ��l 'L . (Phone) �� 3' �- � 5 7 � 2'
(Contact Name) � l�-r� lN i v�C, �S S (Phone)
(Address) �"Z� 2q v�� -� rw� �r � `JO� , �l m �,� Sy��
TYPE OF WORK ❑ New Construction �Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑UtilityConnection r S�C. �+
�-✓1 �'�-�� �? e 10�-�-�SC. '4-k�'Ju.-�0. �.. �� ��
CODE: ❑I.R.C. �.B.C. t$ Misc: 'Ff � t �' Q E�ed c,u,r�
Type of Construction: I II III IV V A B ��
Occupancy Group: A B E F H I M R S U PROJECT COST/VALLTE $���0 -S�-
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished infarmation on this applicaaon which is to the best of my ]mowledge true and correct. I also certify that I am the owner or authorized agent for the
above-me 'oned property and that all rnnstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official r voke this permit f'ust cause. Furthermore, I hereby agree that the city oflicial or a designee may enter upon the property to perform needed inspecaons.
x � �� �D: �f�"I772Z07 9IZ�I fJ
Si re Contractor's License No. Date
Perxnit Valuation 0 � Q � o � Park Support Fee # $
Permit Fee $ 3 . -�s SAC # $
Plan Check Fee $ y c� Water Meter Size 5/8"; 1"; $
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State Surchazge $ �, d0 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Pernut Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ � 6
This Applicarion Becomes Your Building Permit When Approved P�d Re i t NO.
Date B
Buildin Official Date
This is to ttrtify that the request in the above applicadon and accompanying documents is in accordance with the City Zoning Ordinana and may proceed as requested. This document
whrn signed by the City Planner wnstitutes a temporary Certificate of Zoning wmpliance and allows construction to commence. Befare occupancy, a Certificau of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspectlons (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 553'72