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( -PRIp CITY OF PRIOR LAKE BUILDING PERNIIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
��
4rNNE c 1 -
. t. `a'°`" Fite z. Pink city PERMIT NO. /3 _6, 9 r
3. Yellow Applicant
(Please type or print and sign at bottom)
. ADDRESS ZONING (office use)
I V)Gc Tr 1. P v \ c r LI .fix SI) --- f - ;�
LEGAL (office EGGAL DESCRIPTION (oce use only)
LE
LO BLOCK ADDITION PID
(Name R � ` C' , I ( nc t I () (Phone) ( - (00
(Address) '7 Vi S RUC J ! r \ . r I cv Ll,�- \te) 1'y N, - J ?'
BUILDER (� ' f
(Company Name) 0 V t —4 Ckb ) , (Phone) (Q� I -1 g `f -- //-I' - �- (e �' �o
(Contact Name) (Pb o e c J�SSI - / Z ` P Lt
(Address) `h Li A XO MN SRD lu�•� Stomremodelersinc.com
TYPE OF WORK 0 New Construction ❑Deck ['Porch DRe-Roofing ❑Re- Siding ['Lower Level Finish 0 Fireplace
DAdtiition DAlteration ❑Utility Connection tit CODE: QLB.C. 01.13.C. Misc: 0 - A ' .) ' CE'r Tern 1
Type of Construction: I 1I III IV V A B 1�, '(1 j Cr - 0 `' -C\)C . P �" • e.
1 Occupancy Group: A B E F H I M R S U PHo t C� C $
Division 1 2 3 4 5 (excluding land) 1
I hereby certify at I have hed 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
bove -mentio d p roperty a hat all oonatrn will conform to all exis ting state and l ocal laws and will p in accordance with submitted plan 1 am aware that the buil ding
official oke 't just ca. Fnrthore, I hereby agree that the city official or a designee ter upon theproperty to perform needed ' I ons.
1 eX C + fit (0 3
Signature ( Contractor's License No. Date
Permit Valuation
1 ( I Park Support Fee # 1 $ I
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 $
1
Sewer & Water Permit Fee $ Other $
f Gas Fireplace Permit Fee $ TOTAL DUE $ 79 7f
This Application Becomes Your Building Permit When Approved Paid g y 73 Rece t NW 912 Date kiaii1.3 _ BY ■ � /iJ
Building Official Date J
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 $
_ _---- pedal Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
j646 Dakota Street S.E., Prior Lake, Minnesota 55372