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� �n �� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
r � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"i �—_ � `� AND UTILITY CONNECTION PERMIT
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r�r � S O
'"''"� F',e PERMIT NO. �� -� JL f�'
z. r;�t c�ry
3. Yellow Applicant
lease or rim and si at bottom
ADDRESS ZONING (oflFice use)
��U� I�d� �u � 1�11�
LEGAL DESCRIPTION (oflE'ice use only)
LOT BLOCK ADDTTION PID
OWNER p,
(Name) Y �' � � (Phone) � S 2'" L � � � ��S�C+
(Address) ?i 4 1!�- �� 1 j � t � � �-
BUII.,DER p
{Company Name)� � � � �k �-PJ�' I (jr S (Phone) �� 1–�� � b 4
(Contact Name) (Phone) ��(–� � b �" S��
(Address) � � �'S S /', '�.� � 7'YL�'�✓ I l LF � �
�E oF woxx ❑ rr� co���� ❑D� OPorch � 2e-Roofing ❑Re-Siding �Lower Level Finish ❑ Fireplace
[�Addition []Alteradon �]Utility Connection
CODE: �I.R.G �I.B.C. p Misc:
Type of Constnution: I II III IV V A B _ .. -_
Occupancy Gronp: A B E F H I M R S U PROJECT COSTlVALUE _� L�� �+� ��
Division: 2 2 3 4 3 (excluding land)
I hereby certify that I have furnished inCoimation on this application which is to ttte best of my knowtedge true and comct. I also certify that I azn the owner or anthorized agent for the
above-mentioned property an that all construction will conform to ap eacisting state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official e' j cause. Furthermore, I hereby agee that the city oiflcial ar a desigiee may enter upon the property to perform needed ' 'ons.
�=--- I3G Sa�tqSl Z_.- Z
ignature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size S/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 DiTE $ �. 7
This AQplication Bcrnmes Your Buildin� Peimit WNen Approved Paid Recei t No.
' Date B
, Buildin Ofticial _ Date :
17ris is ro cerdfy that the request in the above application and accompanying documents is in accordance rovith the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Cerdficafe of Zoning compliance and allows coastruction to commence. Before occupancy, a Certi&cate of Occupancy must be
issued.
Plamilng Director Date Spacial Conditions, if any
24 dour noNce for all inspections (952) 44�-9850, faz (952) 447-4245
4646 Dskota Street SE., Prior Lake, Minnesota 553'72