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Jul. 11. 2011 3 ; 53PM No. 0908 P. 1
tRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Reed TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
;,4rtigOrs" r. Won Pile PERMIT NO Ap I / / 737
Yellow appltuer LL
(Please type or print and sign at bottom)
ADDRESS ZONING forrrreuse)
g C l (4 RA l ''tti�
LEGAL DESCRIPTION (office use only) •
•
LOT • BLOCK ADDITION PID '
( I n r � /� "
(Name ) V I t (.' _1 V t l t a i (phone). 4-4 1- 2 CX
(Address) &-(t a O it .
•
BUII,DER �\(� 1 Il . I Y+ (Phone) v 1 S L" 4 0 Z - 3g4''
(Company Name) 1 �,( p
(Contact Name) , : V 11 I� ,C•Vtk)Yl .Y 1 (Phone)
(Address) ,)() \(( , ' Y l i
TYPE OF WORK 0 New Construction ❑Deck ❑Porch � DRe-Siding ❑Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ❑Utility Cohn ttdn
CODE: .01.R. C. ❑I.B,C. - ❑ Misc. •
Type of Construction: I II III IY V AB PR.O3 CT COST/VALUE $
1 ILA' U 0 .
Occupancy Group: A B E F R I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 have 14mished information on this application which is to the best Of my knowledge true and correct. I also certify that lam the owner or authorized agent for the
abovc•mcnttoned property and that all constriction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that ncc building
official ca evoke this . • r t it forjust cause. Furthermore. 1 hereby agree that the city officiator a designee may enter upon the property to perform needed tnspccnons.
X . / 204'321 g.3 g (1/(1
Signature Contractor's License No • Dare
Permit Valuation Park Support Fee # S
Permit Pee ' S SAC # $
Plan Check Fee Z; Water Meter. Size 5 /g "; 1 "; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
. Plumbing Permit Fee $ Water Tower Pee # $
Mechanical Permit Fee $ Builder's Deposit • $
Sewer & Water Permit Fee $ Other S 1 q 'l `. /
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid Re lit No.
Date .1 , , t By r
Building Official Dale l
This is 10 ceniy that rite Moats' in the above appticauOn and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as r equcsrcd. This document
When signed by the City Planner cOnshtutes a temporary Certificate of Zoning compliance and allows consnucrion to commence. kfore occupancy, a Cettificate of Occupancy must be
issued.
Planning Director Date Special Conditlons, if any
• 24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372