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CITY OF PRIOR LAi� BUII,D`ING PERNIIT ,
�' TEMPORARY CERTIFICATE ' �' �ate Rec d
� � OF ZONING COMPLIANCE
� AND UTILII'Y CONNECTION PERNIIT
� E S ���
1. Whin File : �
�. � ���. PERMIT NO. �3 _ � ��
CBSC OI RDA 8 8L LOttOnl 3. Yellow Applicmt
ADDRESS �
Z�NI�TQr (office use) '
/ 773 "
LEGAL DESCRIPTION (oe('ice use only)
LOT BLOCK ADDITION PID
OWNER �
��e) . �JvL�� !.(�,� (Phone) �� a -r��a - �o �
(Address) � l � S3 , � o ,�
BUII,DER
(Company Name) �� ��.�- (Phone) � - � g �t' - o'�- �2 �-I' �o
(Contact Name) (P o el�� - � g' 'o� � (p
(Aaaz'�s) 1 �vu� N SSC� � ju�y.� cus omremo e ersinc.com
TY�PE OF WOBg ❑ New Construction QDeck ❑Porch �Re-Roo
�8 e-SidinB OLower Level Finish
DAdsiirion �Alteration �Utility Conneetion 5" � F ����
�.
CODE: [�]I.R.C. �I.B.C. '
I�Misc: U2 `
T�e Pf Co�on I II III IV V A B ^
Oc�ancy Grovpe A B E F H I M$ S T7 PBOJECT CpST/yp,LUE $ �(J ,'7DD . v �
Ihv�si°n: 1 2 � 4 S (�� ��•
I hereby certify that I have fiunished infoxmadon on this pplicatioa wluch is to the best of m lmow
above-menaoned and that alt conshnctioi conform to all Y kdSe une and �aect. I also cer�fy that I am the oaaa or anthorized agent for the
e�risting state and local laws and will pzoceed in acoordance with snbmitted plans. I am awaze that the building
official can revo 't for jast canse. Furth e, I hereby agree that the city official or a designee may enter u the
C 12U /7 � ���d;�;�.
X � � 1�
S � Contractor's License No.
. Date
Permit Valuation Paxk Support Pee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; i"; $
State Surcharge $ Pressure Redu�er $
Penalty $ Sewer/Wat�' Connection Pee # $
Plumbing Pexmit Fee $ W�ter Towex ee # ,$
Mechanical Permit Fee $ Buil�er's Deposit $
Sewer & Water Permit Fee $ 0 ��, $
Gas Fireplace Permit Fee $ TOT,AL DUE $
TWs AppHcation Becomes You� Ba31d}ag Permit Whea Ayproved Paid,
Rec t
Date g
Buildin Official . . Date
This is to ceitiPy that the request in the above applicadon and accompanying documents is in accardance with the City Zoaiag prdinance and may pro�ed as requested. This document
when signed by the Ciry Planner constimtcs a temporary Certificace of Zoning campliance and allows constracGon to commence. Before occuPaaCY� g Certificate of OcCUpancy must be
issued.
Planning Director Date
Speciel Condidons, if any
24 Lour notice for all inspections (952) 447-9860, faz (952) qq7.4yqg
�i46 Dakota Street S.E., Prior Lake, Minnesota SSi7y