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( �,) CITY OF PRIOR LAKE BUILDING PERMIT, D.Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE I. white City PERMIT NO / , g,5--
? Pink Cit
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
` 7 , --52 ✓1 _z-. -a /, a J Pl',� rc-- /e? / ).1 A/. R / L�
LEGAL DESCRIPTION (office use only) %�
LOT= / ADDITION 5 1 , Y2 SeZ S� e2,NN�L' ✓? PID 5 13 t -2a? - d
OWNER P') i �( �-1 (Phone) 95 4 9/'/ J� / 7
(Name) `�'��
(Address) _..S u- 7`k Y 07 2 ,J f j 7)'141
BUILDER ,
(Company Name) /41?-4)( /Z- -'U n `/ t " S` )-47r� (Phone) /l 1° f - '7 74 7
(Contact Name) / ' „e, /h'1 12.r''l '^-m (Phone)
(Address) 91 (:),e, . Le 6,..,4,-, , , P Le a./1�., ,11A/. —5 Y' .2 y
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TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Ni'c�L - i. 4 1. ; ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connction �
CODE: DI.R.C. DI.B.C. ❑ Misc.
Type of Construction: I II III IV V AB
PROJECT COST /VALUE $ 7, UZj
Occupancy Group: A B E F HI MR S U U •
Division: 1 2 3 4 5
(excluding land)
I hereby certify that I have punished 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 pro erty 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 revs ke is permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necde inspections.
A'112)/1'---- 3 7/ /3
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ l — —C) SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; I"; $
State Surcharge $ 3 ( ) 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 $ q q't _co
This Application : ecomes Your Build' Permit Whe App ved Pai 1 /7 13 O Receipt No. (: �g `"
S i
,r U 7 Date i� By Sf■
Aill
Building Off al 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 Prior Lake, MN 55372