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� CITY OF PRIOR LAKE BUILDING PERMIT, (` / Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE v
AND UTILITY CONNECTION PERMIT
1. White Pile
2. Pink City PERMIT NO. , I _ t)SQ
(Please 3. Yellow Applicant
( type or print and sign at bottom)
ADDRESS ZONING (office use)
\ ,,f,v, Cat..e1 tie.. t Vow- L`4
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER '
(Name) L- v� .l W42-7k) (Phone) q.0 -- ,:a3 3 - 3 50 ;
(Address) kl4tAlS I vQv1 C„,, -` g E l P r t_ r"1ee , J'4 4 SS3-7a-
BUILDER c
(Company Name) £G4em r rS V 1 L LL (Phone) /50 — 3 `QS -),-/ eJrr
(Contact Name) terful 14.3iri41.i (Phone)
(Address) V k\ Skw-,- d A.R. S / S�+wt.� - /t-1 •A) SS 3- 7 c e
TYPE OF WORK ❑ New Construction ['Deck ['Porch Ord re-Roofin DRe-Siding ❑Lower Level Finish ❑ Fireplace
['Addition DAlteration ['Utility Conne lion
CODE: I.R.C. ❑I.B.C. Xmisc, 2 J n . .►►' wJ ekiray,e '- , /1-
Type o C onstruction: I II III IV V A B e �v
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ "7 W2 Z_
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 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
official can rev ke 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 o2 ble 373/ c)-- 'VS' /
ignature Contractor's License No. Date
Permit Valuation ) r V U Park Support Fee # $
Permit Fee $ 7 L/ e 7 <- SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ S . U 0 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 $ —7 C?/ , - 7S
This A. lication :eco. - J our Building Permit When Ap. ove! Paid 7 Y . 755 Receipt No. (p ) I / q ,
AL/ . ON "� _ 7 Date "? — — l By �fi
Builm • • ci•l '"
This is to certify that the request in the above application and a ccompanying 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