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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" t '' AND UTILITY CONNECTION PERMIT �� Z 7� � Z'''
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1. White File pERMIT NO . %'f —/.. �
z. r�� c�ty
3. Yellow Applicant Gs ( {/
lease e or rint and si at bottom
ADDRESS ZONING (oflelce use)
���Jov Cc��� �� t 1�1�-� MJ� 5� ���.
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
(Na�me R �J'� \ V (Phone) ��Z 23� ` 1 �
(Address) , �} � '[� e � \ �J� �l
BUII.,DER `/ t- - `,, {
(Company Name) � �Q�1 Y�O.,t C� 1� ?C-�T f l G� 5 . LL C (Phone) � ��-` �o�I � = �9 �� �
(Contact Name) �C�S �P`(�1(�I�C.X (Phone) �2 2 ��� � y �D �9
(Address) �'�2 � \ e0 �, V � � �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �te-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc: Y . �
Type of Consiruction: I II III N V A B ���,
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ II�T`1 '�
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished information on this application which is to the best of my knowledge true and mneM. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all conswction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official can revoke this pemtit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspedions.
X ��lu�--- "C3C1�3�'�p3 �-25 12
Signature Contractor'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 $
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Tlus Application Becomes Your Building Permit When Appmved Paid Re ' t No. �
Date - � '2r._ B
Buildin Official Date
This is to certify that the request in the above applicallon and accompanying documents is in accordaace with the City Zoning Ordinance and may proceed as requested. 7'hisdocument
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows conswction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372