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o�= �- I��i' �"I�`Y flF PiZI()R LA�; BUILDING PERiV1IT, Date Rec d
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�/ %'" ;���- fiE1�1PQRARY CERTIFICr�TE OF ZONING COMPLIANCE
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�? � � f � � �� � AN� UTiLITY CUNNECTION PE.RMIT
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3. Yeltow AQplicant
�C3SC O[ t i!lit; SI 3C $DCl''CCt►Yitj — 7 ���
�L11Ta70 • 401ti1�� tO�IOC i1SCj
L� Z-Co � I�tJ l l � S f��. r- I.c w�_
LEGAL T�ESCRTPTIC}l! {ot�'ice esse ou�y)
LU'T BLf}CK A1�I�ITIO� pID
OWNER �"—"
�� -� C`� �- � C C� � �. QS� (Pho�} �to � 2 Y Z � 9 ^ �� � 3
(Adclress) F� 2— �� � �.1� l lC�-S � Gf�W
BUILDER �" C C�t�''�T'� C�/LS� �.��t� (F'ho�e) �� � — �o' � �
(Company Name}
(Contact Name) _��� If L Q r�1 �"' ` {Pho�) �� 5 ( '- '-( Zc� ° !o S' b (o
(Address) � '� �{ S' � L�n. ( -2-'�"� �J"� 'S 'F'" �/E't-�-, .� I� � � � � �
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TYPE UF WURK ❑ rsew co�auc.�ion Clrx� �Po�n ❑� xoo�g [�-sia;� �r.ow�r rx� g� ❑ g�n�a
[]Addirion �Attcration �]Utility Connection � � J CO2p�/�g �, '�t� � ' �`,
COD$: �I.R.G (�I.B.C. ❑ Misc: ��O�.J u� c� � L�� � t
Type of Canstivction: I II iIi Ti' 'i� A B ,2 �( �•2
(k��ecp Groop: A B E F H I M R S U PB�Q3SCT CO3T/VALUE S��! _
Division: 1 2 3 �: S (e�cd�i�g 1�)
I hereby artify tIlat I have fumished mk�► am this applicatian whxtt is ta tde best af my 1o�vrbdge aue md cv�roct I aiso oateEy 1l�at I am tAe opvncr or as�cd eSent fos tl�e
abavc�mentioned P�Y �d that ali o�shnudoa wilt oonfrnm to aiS e�ostiug �e and Iacai lavrs and wiN ptnoeed � aaoo[daea with �od pian^+- E am aware that the b�ildvjg
afficiat caa � th' cause . t benob3+ aSee i� the cily offxasal ar s de�ee m�ry �tr upoo f�c psnpeitY � P�� ��•
� __------�- ------__.__. _ _ �3 c, s� �� � 19 � �zc�r�Z
_ __._ .___
$i tll COIK�CtOT'S LdCCIISC NO. D'dtC
�_.___�____�..__._..___..__ ��.._._____._,___��----_�-._�-
Permit Vaivation Pazk Support Fee # a
Pemiit Fe� $ SAC # �
Pian Che�k Fee 3 Water Me�ter Size S/8"; i"; S
State Surcharge � Pressure Reducer � .
p����, � SewezJWater Conn�tion Fee # S
Plumbing Permit Fee $ Water Tower Fee # S
Mechanicai Permit �ee 5 Buitder's Deposit �
Sewer & Water Pe�rtit Fee $ Other � $
Gas Fireplace Percnit Fee $ TOTAL DUE $
Tltis A.pplicarion sccvmes Yo� Bru78i�g rerm:c wbe,e Ap�avcd Pairl " No.
' Date B
Buikdin O�cia1 t�a��
'i'his 's oo actif7i thar the nequest in tke a6ove � aad a000m{rm►y�g dacumaas is sn a�000nlana with Ux C'ity T.aaio8 Oc+diaanc� �Y ���• 'Ihis �cu�a
whm s�gned Dy ct�c C;ty Planner canstianes a te�ary Crra6ca�c of Z� mmplianoe and ailaws o� to oauomamee. BrFose occapaacy, a CeitiRcate of Oavpancy must be
issued_
-- -----__—_. _._._...._ __---___.�..�_� �_____._._....._ _ � . -
Pl�ning Dirrctor T� � ��' if �
Zd ho�r aetiee far ali isspt�tieas (952) 447 4859, i�uc {�52) 4l7�12�t5
464� Dal�ta Strect S.E., Priror Lakc, Mieeesota 55372
oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
'4j i wn��e File pERMIT NO
2. Pink City ���� � �
3 Yellow Applicant �
Please or rint and si at bottom)
ADDRESS � ZONING (ofTice use)
� � ,� ` \ �1 `' Z ' �'
:
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
OWrTER
(Name) O — C: �� � (Phone)
(Address) 1 � � � 3 � � � �S - � ,
BUII,DER � ' __ -
(Company Name) � � O � Z� � i: i.c � �tia/ —L� (Phone) ?G �
(Contact Name) �l f�. � c.' D t�� � (Phone) 7� 5 .s 2 � S' "�� �i '
(Address) �1� � s Gy �S C� C / l � /(� � � 7 j �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certity that 1 have fumished information un this application which is to the best of my knowledge tnie and correct. I also certify that I am the owner or authonzed agent for the
above-menhoned pr rty and t all construction will conform to all existing stare and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revo permit f�st cause Furthermare, I hereby agree that the city official or a designee may enrer upon the properry ro prrform necded m ccuun.
X ':`� � cT2� 2a � 2`� � t� � s" ��
Signature Contractor's License No. ate
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 $ �t`
This Application Becomes Your Building Permit When Approved Paid Recei O
Date B
Buildin � Ut7icial Dnte
This �s to certify that thc requcst in the abuve applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. This document
when signed by the Ciry Planner cunstitutes a temporary Certificate of Zoning compliance and alluws construction to commence. Befure uccupancy, a Certrficate uf Occupancy must bc ,
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372