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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �
., x AND UTILITY CONNECTION PERMIT � ` � , � �''�
� �
'yj I. White File
z �,�, �„ PERMIT NO. i 2-��' �,:�
3 Yellow Applicam '
Please e or rint and si at bottom)
ADDRESS ZONING (otlice use)
161Gt DNh � �
LEGAL DESCRIPTION (of�'ice use only)
LOT BLOCK ADDITION PID ��
(N�e R �v���C �o���,�f�} (Phone) °I�i2' �� �s3�
(Address) �(v7(� n+n�. R.� � Qr;a( �e� /�'�A) S�j31Z
BUII.,DER
(CompanyName) F4d��.N„ Wtl�er �hsk (Phone) ff66-�?�
(Contact Name) 7t� (Phone) 7(,� - 77 Z'ZZ �) �
(Address) 7 U n; v.c c i� A�c N fr : d �t /h IU 5� �3 Z
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing �Re-Siding ❑Lower Level Finish ❑ Fircplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Consdrudion: 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 certify that 1 have fiimished information on this application which is to the best uf my knuwledge true and correct. I alsu ceRify that I am the owncr or authonud agent for the
above-menuoned property and that all construction will conform to all exisnng stare and local laws and will proceed in accordance with submitted p(ans. I am aware that the buildmg
official can r his permit f just use. Furthermore, I hereby agree that the ciry otl'icial or a designee may enter upon the property to prrform necded mspections.
X � i3C• �IN3Z5U 6�ZG/�2
Signa 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 $
'
This Application Becomes Your Building Pernut When Approved Paid ei t NO.
Date ,
BuilJin � Utticial Date ,
Thu rs to crrtify that the requcst in the above applicahon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceeA as requcsted. Th�s ducument
when signed by the Ciry Pianner consutums a temporary Certificate uf Zoning compliance and allows construction tu commence. Before occupancy, a Ceruficate uf Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372