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• Jul. 11. 2011 3 :54PM No. 0908 F. 7
(
PRio CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE L/
M AND UTILITY CONNECTION PERMIT
4 1. Willie rilo
2. Pink sty PERMIT NO. // - ,
S Mo. Appi{G„i
(Please type or print and sign at bottom
ADDR$SS ZONING (office use) • 1G1 13 h L fm( I.
LEGAL DESCRIPTION (omce use only)
LOT BLOCK ADDITION PID
OWNER .
(Name) C G L l � ' (Phone) ,, L -. 1 C I 4 - 3 4 K2
(Address) dr-1,,t` 0 0 v -e .
( C ER q52 4(1 -3 /2
(Company Name) 4. , k i I re , (Phone)
Al Contact Name) _ / V p ( Cf. � V--o (:) V.S-C4 (Phone)
•
(Address) JO f t'1 ` )
TYPE OF WORK. ❑ New Construction ❑Deck ['Porch ; Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
DAddition ❑Alteration ['Utility Connection •
CODE: .0I.R„ C, ❑I,B.c. ❑ Misc. (� / ,, n el
Type of Construction: X II III IV V AB PROMCT COST /VALUE S L Li Le t% . v
Occupancy Group: A 13 E F H 1 M R S U
Division: 1 2 3 4 5 (excluding land)
1 hereby certify that 1 hare flsmished information on This application which is to the best of my knowledge true and correct. 1 also certify that tam the owner or authorized ascot for the
above - mentioned 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
Ad r Ice th' it for just cause. Punhermore,1 hereby agree than the city of icial or a designee may enter upon the property to perform needed mspcctinns.
X r 2 0 C4 32 I g . l 11L )
Signature Contractor's License No. Date
Permit Valuation Park Support Pee ## $__
Permit Fec $ SAC ## • ' $
Plan Chcck Fcc $ Water Meter. Size 5/8 "; 1 "; 5
State Surcharge $ Pressure Reducer ' 5
Penalty ' $ Sewer /Water Connection Pee # 5
Plumbing Permit Fee 5 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other ' ' $ i ?
Gas Fireplace Permit Fee 5 TOTAL DUE r, $ / /
This Application Bccomcsi Your Building ?unlit When Approved Paid Re. - i a t No,
Date 1R1 B
•
, Building Official Dmc
Tuts 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 requ This document
when signed by the City Planner constitutes a temporary Cmifscate of Zoning compliance and allows construction to commence. before Occupancy, a Certificate of Occupancy must be
issued.
Nanning Director 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