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��-'����, CITY OF PRIOR LAKE BLTILDING PERMIT, Date Rec d
�( � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE I�lOLf 0
"i�.� `/ �' AND UTILITY CONNECTION PERMIT �, �� 7
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I. Whife File � pERMIT NO . '�I
z. rink ciry
3. Yellow Ay9icant l ✓
lease or ' and si at bottom
.1DDRESS ZONING (ot&oe use)
�=� S'l-lv ��.tfi �fU�vr z�rn �iv� �e� 5-�-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER r I IUN�i �1 ��� ����� w�' ` (Phone) / 5 �' '�"�l ' `[ � `�r"
(Name)
(Address) �JS CS� 1'r v ��?.L�'1^ G�Y, S'� -.
BUII.,DER ��� Exteriors
(Company Name)_ 8017 Nicollet Ave S. (Phone)
Bloomington, MN 55420
(Contact Name) _ pH: (952) 887-1613 (Phone)
(Address) F: (952) 887-1659
TYPE OF WORg ❑ New Consauction pDeck pPorch pRe-Roofing ❑Re-Siding QLower Level Finish ❑ Fireplace
�Addition DAiteradon �Utility Connection
CODE: DI.RC. QI.B.C. �,Misc: ��y Il/1.U� V► �� GJ��S
1�pe of Consdrnction: I II III IV V A B J
Occapancy Group: A B E F H I M$ S U PROJECT COST/VALUE S1Q. �?� '
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have Cumished information on Wis application which is to t6e besc of my knowledge hve and coaed. I also oertify that I am die owna or authorized a�ent for the
above-mentioned ry and that all construction will oonform to all existing state and local laws and will prooeed in accordauce with submitted plans. I am aware that the building
o6cial can permit for ju t . Furthermore, I hereby a�ee thaY the city officiai or a desigi� may enter u the propeny to paform needed iuspectioas.
X QCUU� S�� � (,� ! � /�i
Signature Contracto�'s License No. ate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size S/8"; 1 $
State Surcharge $ Pressure Reduoer $
Penalty $ Sewer/Water Conneetion Fee # $
Plumbing Pernut Fee $ Water Tower Fee # �
Mechanirai Permit Fee $ Builder's Deposit $
Sewer 8c Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DiTE $
This Application Bernmes Your Building Permit When Approved P3id • Cei t NO
Date
• •
Buildin Official Date
This is to ceidfy �at the request in the above application and a�ompanying documenrs is in acootdance wrth the City Zoning Ordinance and may pmoeed as requested. This docvment
when signed by the City Planner consatutes a temporary Ce►tificaze of Zoning oompliance and allows oonsmution to commence. Bef�e occupancy, a Cerlificate of Oocupaacy must be
issued.
Planning D'uector Date Special C�difioac, if any
24 hour notice for sll inspecttons (952) 447-9850, �(752) 447-4245
4646 Dakota Street SE., Prior I.ake, A�finpeaota 55372
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