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�� � P R I��' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec' d
�� �� �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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,_ i� ____.�' � AND UTILITY CONNECTION PERMIT
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`�'NES�
I. White File pERMIT NO. � _1 ��
2. Pink City
3, Yellow Applicant
lease or ' t and si at bottom
ADDRESS ZONING (ott'ice use)
I�f D'] 5 Sh (3 t��� i.�
LEGAL DESCRIPTION (oflE'ice use only)
LOT BLOCK ADDITION PID
(Na�ine)�q� � K�'�'�.�� �� 12�1 g� (Phone) 9S�' `I'��— L I'S �.�
(Address) J�-I b'] S S w� (��c� ► r� � L E. �' 02, tlV�� . S� 3 "��
BZJII,DER
(CompanyName) STblz.w� ��°s� � l--� (Phone) �51 7 3� 1�o
(Contact Name) J d � W � � � � _ (Phone) �S �- 3 b'� - � y � �
(Address)1355 °��-� ��ut I(�v �. N• 5�,+,�}-i. Pr�� A-t.-F.. N-� - 1•Y
TYPE OF WORK ❑ New Construcdon �Deck �Porch ��te-Roofing (]Re-Siding �Lower Level Finish ❑ Fireplace
❑Addirion �Alteration �Utiliry Connc�ction
CODE: []I.R.C. DI.B.C. ❑ Misc:
Type of Construction: I II III N V A B O� ^,��
Occupancy Gronp: A$ E F H I M R S U PROJECT COST/VALUE S� a!
��an; 1 2 3 4 5 (excluding land)
I hereby ttrtify that I have fumished informarion on this application which is to the best of my knowledge true and correct. I also certify [hat I am the owner or authoriud ageu� for [he
above-mmaoned properry and that all construction wip conform to atl existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X C� 3���0� _ lo�lb�IZ
Sigiiature Contractor's License No. Date
Permit Valuation Pazk 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 S Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ ,, ,�
This Applicatioa Becomes Yonr Building Pernut When Approved Paid Recei t NO 1
Date B
Buildin O�cial Da�
This is ro certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constimtes a temporary Certificate of Zoning comp6ance and allows construction ro commence. Before occupancy, a Certificate of Occupancy must 1x
issued.
Planning Direcror Date Special Conditions, if any
24 hour notice for al) inspectians (952) 447-4850, fax (952) 447-4245
4646 Dakots Street S.E., Prior Lake, Minnesota 55372