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PR 4 , CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd l' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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AND UTILITY CONNECTION PERMIT
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1. white File PERMIT NO .
2. Pink City /3 "
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
560a Lost Hor,'zrn C1r 5'6 � Pries Lake MA,/ .x5
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /4A / Aces �J
(Name) / m r k 4 a Rocco (Phone) 95z — 4 1 90 — o
(Address) S6 00 Lost flari Ztni � ' (r 5 � 'or ,AI(e 01/ 5
BUIEDER CON TR A LTORZ :
(Company Name) 5'an d a u Cpti S LdiO 4 a I Ty , c (Phone) 952 go3 - 9/ a0
(Contact Name) /((/i Sant d't,� (Phone) 1/2-361- 0/2O
(Address) 99 25 Lyhd e , 't1, / & &mini:051Th m/i/ 55
TYPE OF WORK ❑ New Construction ['Deck ['Porch te-Roofing [OIRe- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition EAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I If III IV V A B
Occupancy Group: A B E F III MR S U PROJECT COST /VALUE $ /9, 51 4 /.
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 • owledge 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 tate and lo, : laws and will proceed in accordance with submitted plans. I am aware that the building
offi '. can revok - this per for just cause. Furth - ore, I here., a:. ee that /. ffic'.�Kr a • designee may enter upon the property to perform needed inspections.
i1/// 44' / _'
4f. 13e007251 a7 Z.-‘•
Signature / 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 $ S 79. 7-r
i
This Application Becomes Your Building Permit When Approved Paid 7 y. S _ Receipt N . J qb 4/2_
Date 7/3e43 By = - ' / . ,f
Building Official Date
ate
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