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(p 4p e CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
t, AND UTILITY CONNECTION PERMIT
fir° y
`INE5°
1. white File
2. Pink City 2___ PERMIT NO. / 13/
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5870 Sharrnoh Cir de, SE ft- L/c� , MN 55372 -
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER Q ) 952 - 1 / 4 /7 - /3 (7
(Name) I.) PU.C�. 1 \P,(�l e� OYl e t ,� (Phone)
(Address) 4 Shan/1On el, GIC 56 ]rl'orLd ke. MN 5537,2
- DER eo 1 rrol C71?(L : n
(Company Name) Sancta 4l_ L ')1 f,,,, NOf a l t,'1L (Phone) 5,52 - 4 /0.3 -WOO
(Contact Name) 1(e vih 5an .. (Phone) 6/2 -363 ) /?O
(Address) g9z.5 `..vida/G Ave SD I 8 loo rnilien MN 55 3
TYPE OF WORK El New Construction ['Deck ['Porch ❑Re- Roofing ['Re-Siding ['Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. XMisc: Jnstall 2 replacement pa-ho pa-ho cloors —
Type of Construction: I II III IV V A B E 1 m dtni oam up 4 1 is fa+wtl rcar-' dew �' 4 pL, - b14EN13 Q'NLY
Occupancy Group: A B E F HI MR S U PROJECT COST /VALU $44 '
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 d local laws and will proceed in accordance with submitted plans. I am aware that the building
official revoke this rmit for just cause. Furthermore, ?hereby hereby agre at th ci cial or a desi gnee may e upon the property to perform needed inspections.
Si 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 $ '7973 / -5
This Application Becomes Your Building Permit When Approved Paid 7Y.- / 5 Receipt,. o ± 11/73
Date /6/3j / j1, By -i
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