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Jul. 11. 2011 3 :54PM No. 090$ P. 5
o1 ?Rio CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
. 0 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
1 AND UTILITY CONNECTION PERMIT
lit 4.,h04 BeOlt. is �t any PERMIT NO
r yeow AppIii,. , //
(please type or print and sign at bottom)
ADDRESS ''ii
Le 4g 3 fr v Ft I'l ) f 22 ( I ,S t: ZONING wake um)
t
LEGAL DESCRIPTION (office use only) .
LOT • BLOCK ADDITION PID •
OWNER •
(Name), __ S UZkV'1 /1 -- �_ ° 1 Sz - -.2 ( S�
(P
(Address) 0190 ✓C
BUILDER (Company Name) /'�[ 1 0 n) I C (Phone) - t52 " 4"I z. 3 g ,
(Contact Name) 11' 1 Ict iV C-R/Y (Phone)
(Address) c,\v r d o\ II , NI N __ _
TYPE OF WORK 0 New Construction [Week (]porch I R e•Roofing [Ike-Siding []Lower Level Finish ❑ Fireplace
D�
DAddition DAlteration AR!" Connl�ctibn
CODE:. f x.R,C. OI.B.C. D Misc. Q 426, 0 0
Type of Construction: I II III IV V A B PROJECT COST/VALUE S , /�
Occupancy Group: A B E F III M R S () (excluding land)
Division: 1 2 3 4 5
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I hereby certify than I have Nmished information on this application which is to the best of my knowledge irue and correct. I also certify that 1 am the owner or authorized agent for the
I I abovc•menuoned property and that aU cvnstmuion will conform to all existing state and local laws and will proceed In accordance with submitted plans. 1 am aware That the building
official can revoke this permit for just cause, Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
_
Permit Valuation • Park Support Fee # $
Permit Fee . $ SAC # '— $ •
Plan Check Fee $ Water Meter. Size 578"; I "; $
State Surcharge T Pressure Reducer r $ ----,
Penalty ' $ Sewer /Water Connection Fee # $
PIumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit ' , $
Sewer & Water Permit Fee $ Other $ /
Gas Fireplace Permit Fee S TOTAL DUE .
I $ / '--.---
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This Application Becomes Your Building Permit Wheat Approved Paid Re ipt No.
Date , l l By
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zuning Ordinance and may proceed as requested. This document
when signed by the City Planner cunstuules a tempouary Certificate or Zoning compliance and allows construction 10 Commence. fiefore oCenpanCY, a Certificate of Occupancy must be
issued.
Planning Director Dale Special Conditions, if any
24 hour notice for all Inspections (952)447 -9850, fax (952) 447.4245
4646 Dakota Street Prior Lake, MN 55372