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i CITY OF PRIOR LAKE BUILDING PERMIT, 0t Date Recd
4-, j:
ivivso v 1, TEMPORARY CER'I'it'ICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT il
I. White File
2. P PERMIT NO / /') - ,
Pink City
3. Yellow Applicant (,,!
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 62 Lh . Or
LEGAL DESCRIPTION (office use only)
T� BLOCK ADDITION PID
(N 3C1'O Snejk (Phone) _ d� (SOtCD - n9
C "I5
(Address) 1 1 ve_ _(12, -
,h. P Y LQ.■4) M1' )?)•-•
BUILDER ` _ (, Q f
(Company Name) D/� W1 F � G �� x g�j / (Phone) (Ci `-t'
1 -1 S a te O
(Contact Name) `�J e gcu c�S _ g L i - Li (�
(Address) `7h q , �°� m N Sso Jud h stomremodelersinc. corn.
,46.k.l . TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Roofing DRe-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration 0 Connection
CODE: DI.R.C. D B.c. X Misc: G j lil hdOii r t p i c i c e T v a t s 1 h 1
Type of Construction: I 11 III IV V A B IS l h2 0p1 Ircj- � o BiTUCtU'(r C rf -Aingc .
Occupancy Group: A B E F II I M R S U 0 CT COS VALUE $
Division: 1 2 3 4 5 (excluding land) ' (Q0 00
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 ... 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 . r oke this pe ...' for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ,, 41 .,.�,` C 0 > 4/ c3 i?
A I . tare Contractor's License No. Date
Permit Valuation Park Support Fee # I $
Permit F cc $ 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 ApF roved Paid f 1 (f i Receipt No. k^ (j C
Date 12Ci I p By s
Building Official Date e.-
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 (9521 447-9850, fair (9521 447-4245
1646 Dakota Street S.E., Prior Lake, Minnesota 55372