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0 CITY f PRto�
OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5 Z¢
AND UTILITY CONNECTION PERMIT
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4fiA'NESol.P I. White File
2. Pink ;,Y PERMIT NO . f3
3 Yellow Applicant 1
(Please type or print and sign at bottom)
ADDRESS I ZONING (office use)
X 56 G 3 Los f- �b4r,�..D,nC r c (e SE , R'i'o L4 t- le--1,1D
•
LEGAL DESCRIPTION (office use only)
LOT (o BLOCK ¢ ADDITION S 7123 A /6 ' /61 ' 4-11 PID 25 JOS 05 0
(Name) JA -colt A-• 4 k2 RL 1 . �Av�C+C ,it Jt- (Phone) ` f5 2. 2 26_ '308'
(Address) S 6 s3 L os 7 Y -c2et Ces SE Pri 4Gr MO; /e (60)716. I 7t�U
BUILDER
(Company Name)�OSOvt�o/,n$01 CO (re k ir 14 - C- (Phone) ' o 3O. Cs2.G
(Contact Name) J 5 0 ✓) J. !n s^ S Orl (Phone) t t
(Address) Le C fey t M 0 t5L 0 i ?
TYPE OF WORK ❑ New Construction eck ❑Porch ❑Re- Roofing DRe- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: DI.R.C. DI.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have i ished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the owner or authorized agent for the
above - mentioned proper an. that - nstri tion will onform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
A official can r • c e t •rmit- • se. 9 u • . <, I hereby agree that the city official or a designee may enter upon the property to perform needed inspectio s.
x a Vi _ a o 31' 3 0 0 to
Signature Contractor's License No. ate
Permit Valuation / 4-61 0 ` 0 0 Park Support Fee # $
Permit Fee $ S¢ 1 SAC # $
Plan Check Fee $ 35. 2-6, Water Meter Size 5/8 "; 1 "; $ •
State Surcharge $ r 70 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 der1r, 5/4g $ ?a, 21
This Ap / • ti. �i : ecomes Your Building Permit ' en ' pproved Paid 90 a./ eceipt No. ( UI 17
.44 1 f '
Date 5. z 4 , kJ )3y,
i Jul ., i cial 1 to
This is to certify that the . in the above application and accompanying doc iments in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed b C Planner constitutes a temporary Certificate of Zoning • •mplia. e and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
0
'lannin �i • -- Date Special Conditions, if any
24 hour notice for all inspections (952) 447 - 9850, fax (952) 447 - 4245
4646 Dakota Street Prior Lake, MN 55372
2010 -05 -24 09:42 J J » Le vel3 Broomfield �{oiAse �d� P 1/2
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CITY CF PRIOR LAKE ,.
BUILDING/ • RAN REVIEW •
ACTO £ `„'""" a , 7 ?u . • t `MIT NO.
I . �'C ~ � CE PTED ASS BMI.TTED '" -
A CCEPTED WITF CORFCTIONS AS NOTED
' ❑ N OT ACCEPTE ORRECT 8. RESUBM1T
These consnents are for your inforrnatiOn. Ali work shalt be done Ni
kVA conclave with all applicable building F. zoning code re-
plionlints induding items not specifically noted in this WWI.
KEEP THIS PLAN SET ON SITE AT ALL TIMES.
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