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CI'I'I' OlF' ��OR LA�� �UII,I?Il�� �'E��T, Date Rec'd
�� � � T�l�Oi�� �E�TI�'�CA'I'E O� �ONII�TG COl�P]LIAI�C�
) �� �J'I'II.IT�' C�l�dN�C'I'IOI� PER1��I'�
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1. White File
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3. Yello�v Applicant
(Please ty e or rint znd si�n at battom)
ADDRESS ZONIlVfi (office use)
� 7 !��- GC /�G 5 � ���� � � �.� SS3��
LEGAL DESCIaIPTION (oflice use onty)
LOT BLOCK ADDITION _ p�
OWNER j / q
(Name) �DV� l���Ot/�$t�3� (Phone)���o ' ��� /
(Address) ��C��, .
BUII.,I3ER f � '
(CompanyName) WECG�'���� •-�pMC � ,�jvEl�� � (Phone � 9sa'933 "'��� .
(Contact Name) � �f�E7�t • (Phone)
(Address) J�' �.�g ��"�O��J � �l � C�rJtS ��CK" �y �.5���
TYPE OF WOIZK ❑ New Construction ODeck �Porch []Re-Roofing ORe-Siding �Lower Leve1 Finish ❑ Fireplace
DAddidon �Alteradon �Utility Connection � � ,
CODE: �I.R.C. []I.B.C. �Misc: /��f�� � U/ta//��� �--�c,rcrsr�� Q���''.s
Type of Conslruction: I ]I ffi N V A B de
r' �upancy Group: A B E F H I M R S U PROJECT COST/VALUE $�r��� �
` sion: 1 2 3 4 5 (excluding Iand)
I hereby certify that I have furnished information on this applicadon which is to the best of my lmowledge true and correct. I also certify that I am the owner or authorized agent for the
above-men6oned pro nd thaz all mnstruction will confom7 to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze chat the building
officiai can rev 't for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon ffie property to perForm needed inspections.
x G,�6�C7��1 �
lgnahu'e Contractoi'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 # $
MechanicaI Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ , TOTAL DUE $
This Application Becomes Your BuiIding Permit'9Vfien Approved Paid ReCei t O
- Date B —''
i
Buildin Official Date '
This is to certify tha[ the request in the above application and accompanying documents is in accordance with tlie City Zoning Ordinance and may proceed as reguested. This document
wb� ��ned by the City Planner constitutes a[emporary Certificate of Zoning compliance and allows consh to commence. Before occupancy, a Certificate of Occupancy must be
isE
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, Minrtesota 55372