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Jul. 11. 2011 3:53PM No 0908 P. 2
C1 "FR CITY OF PRIOR LAKE EUILDING PERMIT, n Date Reed TEMPORARY CERTIFICATE OF ZONING COMPLIANCE L/ •
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fa AND UTILITY CONNECTION PERMIT
fa 4'rhNes1't" I. while rite
1. P PERMIT N
Pink C / /
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(Please type or print and sign at bottom) _
ADDRESS ZONING (oMce use)
f (e`f7 c Fl/ `1nJ Ian TV611 I
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID •
OWNER Leo tt c h
(Name) l (Phone) 4+ ,gYr
(Address) /6V q 75 I 1 i 6 r i n IC ( i yi 1 - 1 ( 6 f 1
BUILDER 1
(Company Name) `�- � 1 vV- A 6 i nc . (Phone) - IS7 _ , `T oi 2 SK 4�
(Contact Name) IV 11 K-C_ V‘( (Phone)
(Address) 3 0{ a yr) l f ` -' 1
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch , J1(JRe-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
[Addition [Alteration OUtility Conn v n n
CODE: .DI.R.C. DI.B.C. ❑ Misc. •
Type of Construction: I II MTV V AB PROJECT COST/VALUE S ?d16/0 t
Occupancy Group: A B E F }I 1 M A 5 U
Division: 1 2 3 4 5 (excluding land)
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I hereby certify that f have furnished information on this application which is w the best of my knowledge Crete and correct, 1 also certify that f am the ow= or aothu(ICC0 agent for tilt
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abovecnitoned property and that all construction will Conform 10 all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can r this 1 for just cause. Furthermore, J hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
>r 4 ' t7 - 2 LI 3 , /II / I
Signature Contractor's License No. Date
Permit Valuation .. Park Support Fee # S
Permit Fee $ SAC # $ •
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Plan Check Pee $ Water Meter Size 5/8 "; 1"; $
State Surcharge $ Pressure Reducer $ l
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fcc $ Water Tower Pee # S
— Mechanical Permit Fee $ Builder's Deposit S
Sewer & Water Permit Fcc S Other $ ;
Gas Fireplace Permit Fee S ( TOTAL DUE f I $ 'I i ^ Application Becomes Your Building Permit When Approved Paid ' Re'Cipt No.
Date 1 B ,,(ji
,t i
Building Official Date
This is to emify Thar the request in the above application and accompanying documents is in accordance with the City Ztming Ordinance and may pnweed as requested. This document
when signed by the City Planner cofStitutCS 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 [or all Inspeetlous (952) 447 -9850, his (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372