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�. �� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 3 3 1,
. , .-, . , . . . y-
„
I. White File I
3 . Fe City PERMIT NO. / / /'
(Please type or print and sign at bottom) s. Yellow Applicant ! _
ADDRESS
ZONING (office use)
(5359 'c_c(� C(}7 Ki ti ?iri'e) ( 1-0
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNS� - ''''r' �-
(Name) 1 n hf`� � E (Phone) (0/ 2- 2 3 o . t '� — 9
•
(Address) / 5 ,_ j 9 PY). )t (r& ( l rC S VIA/ Pvc LLe ( 5`537Z--
BUILDER
(Company Name) � � �' e (�--E' p__Nc _ •r` (Phone) / 51- �% � �? Q
(Contact Name) • - II �? m�' [ 14 32 �� /LJ-/ —
(Address) t3i1- J ( C (3 ,„ h .� 5 \.�f(n L� �I 0 1 "l1v t�'� 1
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ction e- Roofin
DAddition DAlteration ❑Utility Conn g ❑Re- Siding DLower Level Finish ❑ Fireplace
CODE: I.R.C. ❑ ❑I.B.C.
❑ Misc:
Type of Construction: I II III IV V A B jj / 11/ Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $` f ' ( 'V c
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above -me tioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c r oke this permit for jus ca se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X _ &.X 4 -4-,-- 2 0( '7'-P)
Signature Contractor's License No. a te
Permit Valuation Park 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 $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 79 7.f---
This Application Becomes Your Building Permit When Approved Paid L 7 7 . 7. 4—
3 eipt No. 4 Z/e9
.3
Date ?„1/., !(
Building Official Date
This is to 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 constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date
Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372