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M � CITY OF PRIOR LAKE BUII,DING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZOlvING COMPLIANCE G�'
" `� AND UTILITY CONNECTION PERMIT / y� 2 "� Z
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� E S��
'. "'h"` F"` pERMIT NO.
z. � �,ty /Z , lo.��
3. Ycllow Applicant
ease or ' t and ' at bottom
ADDRESS ZONING (ott use)
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LEGAL DESCRIPTION (ofl('ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) C7 /�'/Ly�!''✓1��C� /a' C7 � � /� (Phone) `'1 S��- �� 3 ( � ��
(Address) `T" 7 �� ��'�^.��'� � /�/ ��
BUII.DER / � ��{a-- / ? �2 �—
(CompanyName) ( Y�"- ��V'�'' � •�'�u-�.— (Phone) ���
(Conta.ct Name) �� L� � (Phone)
(Address) /�'tu,/w✓ce-- �.e..-�-� l,.�-� SS� ��
TYPE OF WOl� ❑ New Construction �Deck OPorch�ite-Roofing �ReSiding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteradon QUtility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
T�ype of Conshnction: I II IQ IV V A B / ,,,�.
Occnpancy Group: A B E F H I M R S U PROJECT COST/VALUE S ( i�� �
Division: 1 2 3 4 5 (exclnding land)
I hereby certify that I have fiimished informafion on this appGcatioa which is m�e best of my kaowledge true and correct. I also cenify that I am the owner ar suthoriaed ag�ent for the
abovammtioned pmperty and that all construction wilt conform to all existing state and local laws and will proceed in accordanct with submitted plans. I am aware that the building
offi�e ' pecmit for just cause. Furthamore, I hereby agree t6at the city official or a designce may mcer upon the property w puFotm necded inspections.
�G � ���t7 �'l'/'7 // 2—�
� Sigaature Contractor's License No. Date
Permit Valuation Pazk Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; S
State Surcharge $ Pressure Reducer $
Penatty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit 3
Sewer & Water Permit Fee $ Other E
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Bernmes Y�r Bw7ding Permit When Approvcd Paid R i t No.
Date / r B .
Bui(din Official Date
This is to cerdfjr d�at the m�nest in the above appli�ation and accompanying dacuments ia in accordance with the City Zoning Ord'mance and may proceed as requested. lbis document
when signed by the City Planner consbtutes a temporary Certificaze of Zoning compliance and allows construction to commence. Before occvpancy, a CatiBcate of Ottvpancy mu� be
issued.
Planning Director Date Special Conditims, if any
24 honr notice for all inspectioas (952) 447-9850, faz (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372