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� �� YR Rec'd
OF PRIOR LAKE BUILDING PERMIT, Date Rec d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT (-1-13 ( �.i
A'NE5o b D 60 0 1. white File PERMIT NO
2. Pink City NO. p /� -2��
3. Yellow Applicant ,
(Please type or print and sign at bottom)
ADDRE f ZONING (office use)
I (Ct 0 W ei ,91rA,n) -,i4\1J2 SIN)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
—
OWNER ( 0\-- (Name) _ p v •L (Phone) ap - ` IPA/ 0 v ...�J.'
l (Address)
(Company Name) PflT Wit. , t t. CT72.- 1. ?Z -S (P )..1 t . 1 i (2 (Phone)
(Contact Name) b (ry1.1 1 � ( 1 C� + �[ r U tl U (Phone)
(Address) ‘11001, k ' U t1" k *`)Y> B 6vd, lti N U g e 1---0
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection + . 1 UE (� �(1 / CODE: ❑I.R.C. I.B.C. sc:) I 1 f 3 \` (1:'�^' � v" /" 1 Type of Construction: I 1I III IV V A B U 1 1 r• ®t LS
Occupancy Group: B E F H I M R S, PROJECT COST $ - - v
Division: 1 2 45 (excluding land) „------"
I hereby certify that I l : e ■ 4d info • +'.n (*Allis • pplication whicltis to the best of my knowledge true and correct. 1 also certify that I am th owner or authorized agent for the
above- mentioned prop. : all construch. • conform to a -xisting state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this . cause. Furthe . I her - < agree that the city official or signee may enter upon the pro erty to perform de insp ' ns.
X :lam. C—. � , 5 7 J
Signature Contractor's License No. Date
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 I/ (I O t $ J 06
Gas Fireplace Permit Fee $ TOTAL DUE $ 74 , DO
This Application Becomes Your Building Permit When Approved Paid fiffallIIIIIIIIM Recei ENo AJMrf,
Date 'IMIAMIIMM Ag
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