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: PR 104,
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT /b, /.. /
j � ' N E S ' s -
2. Pink City PERMIT NO. // (0 70
3. Yellow Applicant
(Please type or print and sign at bottom) (((
ADDRESS
ZONING (office use)
V372 fn/o/.(,.iot 5-7► -t. L -st' (7)A,try. act)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N ame) DA 1 ()v.e.-ch (Phone)
(Address) W...t
BUILDER
(Company Name) T 'C�Ot^ h1,o * n e v e ��/'1_l/rt�cjlt,r- (Phone) < qq S2 T �� /
�O `��-7
(Contact Name) J PsYV\ -e_i V\'\ 1 r t„krjy (Phone) q52- 2 2 -593^
(Address) 4e61 () 4 / Cc. i i /\uc. ?rx J o r (PS
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e- Roofing ❑Re -Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration
❑Utility Conne r'
CODE: I.R.C. I.B.C.
❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
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 - mentioned perty 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 can rev 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.
X �..--) 2 c3 6 S 7 -7 "7 /d /Z -zol(
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 $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid 1%
R : =ist No. (JTE-t? G 1
Date (7 -
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 a . 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 he
issued
Planning Director - - - Dale _ - - SI vial Conch on il I an) -- -
24 hour notice for all inspections (952) 447- 98511, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372